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WOODS   HUTCHINSON 


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Digitized  by  the  Internet  Archive 

in  2010  with  funding  from 

Boston  Library  Consortium  IVIember  Libraries 


http://www.archive.org/details/doctorinwarOOhutc 


^p  WoQtis  |)tttcl)iufion 


THE  DOCTOR    IN  WAR.     Illustrated. 
CIVILIZATION  AND  HEALTH. 
COMMON  DISEASES. 
A  HAND-BOOK  OF  HEALTH.     Illustrated. 
THE  CONQUEST  OF  CONSUMPTION.    Illus- 
trated. 
PREVENTABLE  DISEASES. 

HOUGHTON  MIFFLIN  COMPANY 
Boston  and  New  York 


THE  DOCTOR  IN  WAR 


WAITING   FOR  THE  HOSPITAL  TRAIN  TO  START 


THE  DOCTOR 
IN  WAR 

By 

Woods  Hutchinson,  M.D. 

WITH  ILLUSTRATIONS 


J 


BOSTON    AND    NEW    YORK 

HOUGHTON  MIFFLIN  COMPANY 
1918 

BOSTON  COLLFGK  LI'  H  vK\ 
CHElSTiSUT  HILL,  MA&S, 


COPYRIGHT,  1918,   BY  WOODS  HUTCHINSON 
ALL   RIGHTS  RESERVED 

Published  Novemler  jqi8 


NjL 


PREFACE 

Believing  that  the  doctor  and  the  sanitarian  would  play  an 
important  and  by  no  means  discreditable  part  in  this  World 
Wary  after  offering  my  services  to  friends  on  the  British 
Army  Medical  Staff,  only  to  find  that  they  could  not  accept 
any  one,  save  on  the  terms  of  taking  the  oath  of  allegiance  and 
losing  American  citizenship,  I  decided  to  attempt  to  visit  and 
study  the  medical  arrangements  on  the  Western  Fronts. 

As  I  had  more  than  half  anticipated,  I  found  there  the 
finest  and  most  triumphant  demonstration  of  what  modern 
science  can  do  for  the  protection  of  the  health  and  life  of 
an  army  or  a  nation  ever  given  in  history,  equaling  if  not 
surpassing  the  hitherto  unrivaled  victory  of  the  forces  which 
save  life  on  the  Panama  Canal, 

Thanks  to  the  personal  kindness  of  the  Secretary  of  War^ 
Mr.  Baker,  and  of  my  friend  Colonel  Roosevelt,  together 
with  the  courtesy  of  my  medical  colleagues,  I  secured  letters 
of  introduction  and  papers  which  made  me  successful  beyond 
my  expectations  in  securing  permission  to  see  almost  every- 
thing of  any  value  or  interest  from  a  medical  and  public 
health  point  of  view,  from  the  Base  Hospitals  up  to  the  Aid 
Posts  in  the  front-line  trenches  and  from  the  munition 
works  and  Training-Camps  to  the  Hospital  Ships  and  the 
British  Fleet. 

I  was  gone  practically  a  year,  from  January  i^  to  De- 
cember 24,  igiy,  and  spent  about  three  months  in  England, 
going  and  returning,  visiting  the  Base  Hospitals,  the  Train- 
ing-Camps, the  munition  factories ,  and  the  re-fitting  estab- 
lishments for  the  blind  and  the  crippled,  winding  up  with  a 


vi  PREFACE 

week's  visit  to  the  British  Fleet  and  its  Hospital  Ships, 
Ambulance  Trains,  and  Naval  Hospitals. 

Then  I  was  granted  a  special  permit  to  visit  the  medical 
arrangements  of  the  British  Army  in  France  and  spent 
nearly  three  weeks  on  the  Front  tracing  the  course  of  the 
wounded  from  the  front-line  trenches  through  the  Dressing- 
Stations,  the  Casualty  Clearing- Stations,  or  Field  Hospi- 
tals, hack  to  the  great  Base  Hospitals,  including  the  huge 
group  Hospital-Camp  of  35,000  beds  at  Etaples,  where  the 
Harvard  Units  are. 

The  English  authorities  passed  me  through  to  Paris, 
where  I  spent  nearly  six  months  making  frequent  trips  out 
to  the  Hospitals  and  trenches  of  the  French  Front,  to  Sois- 
sons,  to  CarreVs  Hospital  at  Compihgne,  Chateau-Thierry, 
the  '^  pays  reconquis,"  the  Chemin  des  Dames,  Rheims 
(twice),  the  Argonne,  Saint-Menehould,  Verdun,  Alsace;  in 
the  intervals  visiting  the  great  Paris  hospitals,  and  schools 
for  re-education  of  the  crippled,  munition  works,  sanatoria 
for  tuberculosis,  homes  for  the  refugees,  and  finally  spend- 
ing four  days  with  the  Red  Cross  among  the  *'  rapatries  " 
at  Evian. 

Ekirly  in  August  I  went  to  the  Italian  Front,  visiting  eight 
or  ten  of  the  big  War  Hospitals  in  Rome  en  route,  and  had  a 
fascinating  four  weeks  on  the  Isonzo,  while  the  big  Italian 
offensive  was  under  way,  which  opened  so  hopefully  and 
ended  only  a  couple  of  weeks  after  I  left  in  such  a  distressing 
temporary  backset.  Some  of  the  best  hospitals  and  service 
for  the  care  of  the  wounded  that  I  saw  anywhere  were  in  Italy, 
and  I  formed  a  very  high  opinion  of  the  Italian  Army  and  its 
organization  and  fighting  morale. 

Back  to  Paris  in  September,  where  I  tried  to  enlist  in  our 
Army  Medical  Reserve  Corps,  but  found  I  was  too  old!  — 


PREFACE  vii 

to  my  huge  disgust;  out  to  our  American  Zone  in  France 
along  the  foothills  of  the  Vosges,  for  ten  days  with  our  boys 
in  their  billets;  thence  back  through  the  British  lines,  to  visit 
all  our  American  Hospital  Units  which  were  serving  in 
English  Hospitals,  nine  in  all,  through  to  London  to  deliver 
the  Chadwick  Lectures  on  War  Hygiene  at  the  Royal  Society 
of  Medicine,  and  complete  my  visits  to  the  War  Hospitals 
and  munition  works;  and  so  on  home. 

It  is  the  first  war  where  the  doctor  has  been  given  a  free 
hand,  and  he  has  responded  by  almost  wiping  out  disease, 
making  the  death-rate  from  it  in  the  camps  lower  than  that 
at  home,  saving  ninety  per  cent  of  the  wounded  and  sending 
eighty  per  cent  of  them  back  to  the  firing-line  within  forty 
days!  and  making  the  death-rate  from  all  causes  in  this 
most  horrid-sounding  and  appalling  of  wars  the  lowest 
on  record,  barely  three  per  cent  per  annum,  and  for  the  past 
two  years  under  two  per  cent. 

As  a  consequence  he  has  become  such  a  valuable  part  of  the 
fighting  force  that  he  has  lost  all  his  former  immunities.  He 
and  his  insignia,  the  Red  Cross,  as  well  as  his  stretcher- 
bearers  and  his  wounded,  are  eagerly  fired  upon  by  the  Huns^ 
who  count  one  doctor  worth  five  hundred  soldiers  and  one 
stretcher-bearer  the  equivalent  of  ten  combatants  and  issue 
orders  to  their  snipers  and  machine-gunners  accordingly. 

He  lives  under  fire,  sleeps  underground,  operates  in  a 
gas-mask,  and  if  captured  is  sent  to  a  prison-camp  like  a 
line  officer,  in  flat  defiance  of  all  the  rules  of  civilized  warfare. 
He  is  even  contemplating  bearing  arms  to  defend  himself  and 
his  wounded.   Blessings  (?)  on  the  Hun!  !  ! 

The  courtesies  shown  me  on  every  hand  wherever  I  went 
were  so  constant,  so  gracious,  and  so  innumerable  that  it 
seems  almost  invidious  to  mention  individual  names.  If  there 


viii  PREFACE 

are  to  be  found  anywhere  a  body  of  more  kindly,  courteous, 
and  considerate  men  than  both  the  Medical  and  Line  Army 
officers  of  the  English,  French,  and  Italian  commands,  it 
would  be  difficult  for  me  to  imagine  them.  I  must  have  been 
an  awful  nuisance  to  them  sometimes  with  my  requests  for 
visits  and  information  in  the  hurry  and  strain  of  open  war, 
but  they  never  allowed  me  to  see  it,  and  my  opinion  of  war  as 
a  school  of  manners  is  of  the  very  highest. 

But  I  do  feel  under  special  and  peculiar  obligations,  for  in- 
valuable and  most  helpful  courteous  permissions  and  assist- 
ance, to  Sir  Alfred  Keogh,  Director-General  of  the  Royal 
Army  Medical  Corps,  and  to  Colonel  Horrocks  and  Major 
Smales  of  his  staff  in  England;  to  General  W.  G.  MacPher- 
son,  of  the  Medical  G.H.Q.  in  France,  and  Sir  George 
Makins,  Consulting  Surgeon  to  the  British  Armies  in 
France;  to  Lord  Northcliffe  and  Sir  George  Riddell,  for  the 
splendid  opportunities  afforded  me  of  visiting  the  medical 
arrangements  of  the  British  Army  both  in  the  Training- 
Camps  and  in  France;  also  to  Mr.  Sidney  Walton,  of  the 
Ministry  of  Munitions,  and  to  Colonel  John  Buchan  and 
Mr.  St.  John  Hutchinson,  of  the  Foreign  Office,  for  most 
courteous  and  valued  assistance  and  permission  to  visit  the 
British  Fleet  and  the  great  English  munition  works. 

My  warmest  acknowledgments  are  also  due  to  our  Am- 
bassador in  Paris,  Mr.  William  G.  Sharp,  not  only  for  most 
helpful  official  assistance,  but  for  unfailing  and  constant  per- 
sonal kindness;  to  M.  Justin  Godard,  Sous-Secretaire  of 
War  for  Sanitary  and  Medical  Affairs,  and  to  Surgeon-Gen- 
eral Tuffier,  of  the  French  Army  Medical  Corps,  for  permis- 
sion and  most  kindly  assistance  and  facilities  in  visiting  the 
various  Sectors  of  the  French  Front. 

For  my  Italian  visit  and  the  most  liberal  facilities  af- 


PREFACE  IX 

forded  me  on  the  Isonzo  and  Trentino  Fronts,  I  owe  my  most 
cordial  and  grateful  thanks  to  the  Italian  Ambassador  in 
Paris,  Marchese  Selva  di  Reggio,  and  to  the  Comando 
Supremo  at  Udine. 

Many  of  the  chapters  of  the  book  have  previously  ap- 
peared in  magazine  and  syndicate  articles,  and  I  wish  to 
acknowledge  my  indebtedness  to  the  Editors  of  the  **  Satur- 
day Evening  Post,''  the  "  Metropolitan  Magazine,""  the  Star 
Publishing  Company,  ^'Harper's  Magazine,"  ^^ Pearson's 
Magazine"  {London),  and  the  ''Daily  Mail"  {London), 


CONTENTS 

I.  The  Triumph  of  the  Doctor   .      .      .      .      i 
II.  The  Real  Perils  of  War 21 

III.  Feeding  a  Million  Men.      .      .      .      .51 

IV.  The  Superb  Health  of  the  Armies     .       .    83 
V.  The   Land  of  the  Happy  Warrior  and 

the  Cheerful  Wounded       .      .      .      -95 

VI.  A  Day  in  a  French  Field  Hospital     .      .113 

VII.  The  Risks  of  a  Red  Cross  Nurse.      .      .  125 

VIII.  Gas-Gangrene  and  Tetanus   ....  132 

IX.  Healing   the  Wounds   of  War,  or   the 

Carrel  Triumph 147 

X.  The  Stranglers     .      .      .      .      .      .      .168 

XI.  The  Drinking- Water  of  the  Soldier  .      .  197 
XII.  Guarding    the  Health    of    our    First 

American  Troops  in  France       .      .      .  209 

XIII.  New  Faces  for  Old  and  Making  a  Frac- 

tion equal  a  Whole 227 

XIV.  The  New  Diseases  of  the  War      .      .      .  248 
XV.  Keeping  the  Camps  Healthy         .      .      .  262 

XVI.  The  Problem  of  Tuberculosis      .      .      .  275 
XVII.  The  Plagues  of  Armies 293 


xii  CONTENTS 

XVIII.  The  Effects  of  War  on  the  Civil  Popu- 
lation        313 

XIX.  Guarding  the  Health  of  the  Navy       .  331 

XX.  Shell-Shock  and   the  Mental  Strain 

of  War 358 

XXI.  The  Health  of  the  Aviator:   Saving 

THE  Bird-Man  from  Extinction  .      .  380 

XXII.  The  University  of  the  Army:  War  as 

A  College  Course 403 

XXIII.  The  Armies  at  Play       .      .      .      .      .415 

XXIV.  The  Pulse  and  Temperature  of  France  430 
XXV.  Mountains  and  Medicine:  Italy's  War 

on  Disease 444 


ILLUSTRATIONS 

Waiting  for  the  Hospital  Train  to  Start 

Frontispiece 
Inoculation  at  Salonica 12 

A  Wounded  French  Soldier  returning  on  Foot 
TO  the  Dressing-Station 38 

Photographic  Section  of  the  French  Army 

A  Group  of  Lady  Ambulance-Drivers    ...    44 
Quinine  Parade  in  the  Salonica  Army   ...    48 

A  WOUNDED  Man  cheered  by  a  Chaplain  as  he  is 
brought  in  on  the  Light  Railway,  Western 

Front 96 

Wounded  on  the  Light  Railway,  Salonica  Front    96 
Dressing   a   Guards   Officer   on   a   Flanders 
Battle-Field 100 

Canadian  Red  Cross  Men  attending  to  Wounded 
Germans  at  an  Advance  Dressing-Station     .  100 

Canadian  Official  Photograph 

In  a  French  Underground  Dressing-Station    .  104 

French  War  Office  Official  Photograph 

Lady  Lorry-Drivers        .      .      .      .      .      .      .120 

A  Cheerful  Wounded  Canadian  Officer  board- 
ing A  Hospital  Train 120 

Photograph  from  the  Canadian  War  Records  Office 


xiv  ILLUSTRATIONS 

A  VA.D.  AT  Work  in  France  " 126 

Sleds    used    for    Conveying     the    Wounded 

THROUGH  THE  MUD  ON  THE  FRENCH  FrONT  .    .  I42 

Arrival  of  Wounded  at  a  French  Base  Hospital  158 

French  War  Office  Official  Photograph 

Transporting  Wounded  to  a  Field  Dressing- 
Station  on  the  Salonica  Front     .      .      .      .174 

Bringing  in  a  Wounded  Canadian  through  the 
Mud  on  the  Western  Front 174 

Photograph  from  the  Canadian  War  Records  Office 

A  Patient  coming  on  board  a  Hospital  Barge    .  206 

A  Fracture  Case  in  a  Hospital  on  the  Western 
Front 238 

A  Stretcher-Bearer  Party  coming  through  the 
Mud 266 

A  British  Tommy  helping  a  German  Prisoner 
CARRY  A  Wounded  German  through  the 
Trenches 266 

Ambulance  and  Dispatch-Rider  coming  from  a 
Battle  on  the  Salonica  Front      ....  298 

Canadian  Wounded  going  to  the  Dressing-Sta- 
tion on  a  Light  Railway 314 

Canadian  Official  Photograph 

Stretcher-Drill:  Taking  an  "Injured"  Man 
BELOW  for  Treatment 346 

An  Advance  Dressing-Station  near  the  Line  on 
THE  Western  Front 3S0 


ILLUSTRATIONS  xv 

Indian  Soldiers  carrying  in  one  of  their  Offi- 
cers       412 

Serbian  Wounded  coming  from  the  Mountains  .  446 
Transportation  of  Wounded  by  Trolley  in  the 
Italian  Mountains 468 

From  an  Italian  Photograph 

Italian  War  Dogs 480 

Italian  Official  Photograph 

Except  as  otherwise  stated  the  Illustrations  are  from 
British  Official  Photographs 


THE  DOCTOR 
IN  WAR 

I 

THE  TRIUMPH  OF  THE  DOCTOR 

Saving  Science  versus  Destructive  Science 

WAR,  like  life,  is  full  of  contradictions.  Aim- 
ing solely  at  the  destruction  of  enemy  life  by 
its  own  legitimate  and  special  weapons,  it  actually 
destroys  and  loses  five  times  as  many  soldiers  by 
disease  as  in  battle,  and  while  waged  solely  between 
armed  men,  its  heaviest  slaughter  has  always  been 
among  women  and  children.  When  a  soldier  bravely 
enlists  for  the  defense  of  his  country,  he  thinks  only 
of  facing  the  risks  of  battle  and  sudden  death,  but 
until  this  war  his  far  greatest  risk  was  that  of  dying  of 
typhoid  or  cholera  in  a  summer  camp,  or  pneumonia 
in  a  winter  one. 

/The  doctor  has  made  this  world-struggle  probably 
one  of  the  least  deadly  ever  fought  in  proportion  to 
the  numbers  engaged.  Less  than  one  twentieth  of 
the  wastage  of  ancient  war  —  that  is,  three  years  or 
more  ago  —  was  due  to  wounds  or  deaths  in  battle, 


2  THE  DOCTOR  IN  WAR 

the  other  ninety-five  per  cent  was  caused  by  disease, 
epidemics,  and  pestilences,  both  in  the  field  and  at 
home.  In  the  armies  themselves  the  ratio  was  six 
to  nine  deaths  by  disease  to  one  in  battle  or  from 
wounds.  In  this  war  the  ratio  has  been  double  re- 
versed—  sixteen  deaths  in  battle  to  one  from  dis- 
ease. 

By  wiping  out  epidemics  the  doctor  has  actually 

kept  the  death-rate  among  the  civil  populations  of 

]  the  Allied  countries  as  low  as,  and  in  some  cases 

(  lower  than,  it  was  before  the  war.  By  redoubling  the 

care  and  protection  of  young  children  almost  as  many 

additional  young  lives  have  been  saved,  as  adult 

ones  have  been  on  the  field  of  battle.   So  that  the 

populations  of  the  Allied  countries  are  practically 

^  holding  their  own. 

jf  C  The  doctor's  control  over  wound  infections  is  so 
i  masterly  that  of  the  wounded  who  survive  six  hours 
I  ninety  per  cent  recover,  of  those  who  reach  the  field 
I  hospitals  ninety-five  per  cent  recover,  and  of  those 
who  arrive  at  the  base  hospitals  ninety-eight  per  cent 
get  well.   The  twin  angels,  anaesthetics  and  antisep- 
tics, have  not  only  enormously  diminished  pain  and 
agony,  but  have  made  amputations  rarer  and  grave 
cripplings  fewer  than  ever  before  in  war  history. 
Barely  two  per  cent  of  the  wounded  are  crippled  or 
permanently  disabled. 

From  the  statistics  made  public  there  is  good  rea- 


THE  TRIUMPH  OF  THE  DOCTOR  3 

son  to  believe  that  the  death-rate  of  this  war,  in 
spite  of  the  colossal  increase  in  instruments  and  en- 
gines of  scientific  slaughter,  does  not  much  exceed 
three  per  cent  per  annum.  The  same  ingenuity  that 
sharpened  the  attack  has  strengthened  the  defense. 
The  spade  is  mightier  than  the  shrapnel,  the  scalpel 
than  the  sword,  the  test  tube  than  the  trench  mor- 
tar. Chlorine  saves  more  lives,  as  Dakin's?  fluid  in  1 
wounds  and  bleaching  powder  in  drinking-water, 
than  it  destroys  as  poison  gas.     ^  ""^ 

An  army  camp  used  to  be  a  hotbed  of  epidemics, 
a  breeding-place  of  pestilences.  The  soldier's  worst 
enemy  enlists  with  him,  for  what  killed  most  men 
in  war  was  not  bullets,  but  *'  bugs,"  not  the  sword  but 
the  streptococcus.  Whenever  you  mobilize  and  call 
to  the  colors  a  thousand  men,  you  call  with  them  at 
least  twenty  billion  tubercle  bacilli,  ten  billion  ty- 
phoid, five  billion  pneumonia,  and  a  couple  of  mil- 
lion dysentery  germs.  An  army  assembles  literally 
primed  and  loaded  for  trouble  —  from  the  inside. 

The  first  thing  an  army  in  the  field  does  is  to  foul 
its  own  water-supply  and  the  second  is  to  infect  its 
food  by  the  swarms  of  flies  bred  in  its  garbage  dumps 
and  manure  heaps. 

In  the  old  days  armies  simply  rotted  with  disease 
in  their  winter  quarters ;  forces  which  had  gone  into 
winter  camp  in  good  health  and  spirits  were  often 
so  reduced  in  the  spring  as  to  be  actually  unable  to 


4  THE  DOCTOR  IN  WAR 

take  the  field.  Gustavus  Adolphus  once  broke  camp 
and  started  on  his  spring  campaign  two  months  ear- 
lier than  he  had  intended  simply  for  fear  he  would 
not  have  any  army  left  to  campaign  with  if  he 
waited  till  summer. 

The  armies  in  Flanders  and  northern  France  last 
winter,  out  in  open  trenches  in  some  of  the  vilest  and 
*'  sickliest  "  weather  troops  ever  had  to  face,  had  less 
sickness  and  fewer  deaths  from  pneumonia  and  all 
other  diseases  than  they  used  to  have  in  barracks  in 
time  of  peace  and  far  less  than  the  general  civil  popu- 
lation at  home. 

Inoculation  protected  them  against  typhoid;  splen- 
did feeding,  with  plenty  of  meat  and  fat,  against 
pneumonia  and  consumption;  fly  campaigns  against 
dysentery  and  diarrhoea;  shower  baths  and  clean 
underwear  against  spotted  typhus;  and  quarantine 
against  all  the  mild,  infectious  measles,  summer 
diarrhoea,  diphtheria,  and  influenza. 

The  old  plagues  of  army  camps,  cholera,  Black 
Death,  and  spotted  typhus,  all  lifted  their  heads  and 
began  to  *' resurrect,"  in  Italy,  in  Serbia,  and  in  Rus- 
sia, but  all  were  promptly  stamped  out  by  modern 
sanitary  science  —  cholera  by  isolation,  disinfec- 
tion, and  the  vaccine,  Black  Death  by  exterminating 
fleas,  typhus  by  ''unlousing"  and  hot  shower  baths. 
**  There  is  no  armor  against  Fate,"  but  when  it 
comes  to  typhus  a  clean  undershirt  pretty  well  fills 


THE  TRIUMPH  OF  THE  DOCTOR  5 

the  bill  and  is  a  better  life  protector  than  any  shirt 
of  mail. 

Only  three  new  inventions  in  the  disease  line  have 
appeared  in  this  war :  trench  fever,  trench  nephritis, 
and  trench  feet.  The  last  two  are  still  a  puzzle  as  to 
causation,  but  all  three  have  been  brought  down  to 
comparatively  slight  proportions  and  importance,  by 
good  sanitation,  properly  drained  trenches,  loose, 
comfortable  foot-  and  leg-wear,  regular  washing  and 
greasing  of  the  feet  every  night,  clean  socks  and 
plenty  of  them.  Trench  fever  has  been  proved  to  be 
carried  by  the  bite  of  the  louse  or  **  cootie." 

The  mental  damage  inflicted  upon  the  soldier  by 
the  horrors  and  strains  of  this  war  has  been  aston- 
ishingly small.  The  total  number  of  cases  of  serious 
or  lasting  "shell  shock,"  so  called,  and  mental  dis- 
turbance in  the  British  Army  in  France  during  191 6 
was  twenty-six  hundred,  less  than  one  per  thousand 
of  the  armies  in  the  field  and  little  more  than  the  ordi- 
nary insanity  rate  in  men  of  military  ages  in  times 
of  peace. 

Modern  nerves  have  stood  the  fearful  strain  of  this 
war  superbly,  and  the  more  "modern"  and  citified 
they  are  the  better  they  stand  it.  Men  of  every  race, 
color,  and  grade  of  civilization  have  been  tested  in 
this  war,  and  while  all  were  brave  and  devoted  and 
with  the  highest  respect  for  the  noble  and  loyal  serv- 
ice rendered  by  tropical  and  Oriental  troops,  none 


6  THE  DOCTOR  IN  WAR 

have  borne  the  ghastly  horrors  of  shell  and  mine 
and  poison  gas  so  well  as  the  highly  civilized  white 
races.  And  without  invidious  distinction,  among 
the  steadiest,  stanchest,  and  most  "shell-proof"  of 
all  stands  the  highly  citified  and  alleged  "neurotic" 
Cockney. 

As  for  the  ancient  and  classic  plague  of  armies, 
venereal  disease,  in  spite  of  the  special  temptations 
to  which  soldiers  in  the  field  are  exposed,  away  from 
home  associations  and  ties,  —  any  pleasure  may  be 
their  last,  etc.,— and  in  spite  of  the  disgraceful 
solicitations  to  which  a  silly  sentimentalism  and  os- 
trich-like Puritanism  permit  them  to  be  subjected 
in  London  on  leave,  here  are  the  figures:  — 

Venereal 
disease 

British  Army  in  time  of  peace  (1905) 12  per  100 

"        "       "      "     "      "     (1913) 6    "    " 

*|        "      athome(i9i6) 3    "    " 

"      in  France  (19 1 6) 2.4    "    " 

In  other  words,  the  average  incidence  of  venereal  dis- 
ease in  the  British  Army  in  France  is  no  higher  than 
that  believed  to  exist  among  men  of  military  age 
in  time  of  peace;  while  in  the  American  army  in 
France,  by  cutting  out  sentiment  and  treating  vene- 
real disease  like  any  other  contagious  disease,  it  has 
been  brought  down  to  less  than  one  per  cent, 
.^  \  If  we  would  stop  preaching  and  exhorting  about 
1    venereal  disease  as  a  moral  problem  and  treat  it 
\  strictly  as  a  sanitary  one,  for  the  duration  of  the  war, 


THE  TRIUMPH  OF  THE  DOCTOR  7 

we  could  soon  bring  it  well  below  Its  former  preva-  j 
lence  in  times  of  peace.  Especially  if,  in  addition,  we 
would  frankly  recognize  the  prostitute  for  what  she 
really  is  —  a  helpless  feeble-wit,  selling  her  body  be- 
cause she  has  no  brains  to  sell  —  and  take  charge  of 
her  as  a  permanent  ward  of  the  State  in  beautiful, 
comfortable  cottage  colonies  out  in  the  open  country. 

If  the  soldier  on  leave  were  systematically  pro-   ~^^ 
vided  with  easy,  abundant  opportunities  to  meet  and 
dance  and  go  sight-seeing  with  nice  girls  and  women 
he  would  never  miss  the  bad  ones,  for  the  minds  of    r 
young  men  are  cleaner  than  those  of  most  of  the-J 
middle-aged  who  exhort  them. 

At  first  sight  it  would  appear  as  If  the  doctor  could 
do  little  to  limit  the  deadliness  and  slaughter  of  war. 
He  could  bind  up  wounds  and  ease  pain  and  nurse 
the  sick,  but  what  could  he  do  to  stop  bullets  from 
finding  their  billet  or  shells  from  bursting  in  crowded 
trenches?  But  this  idea,  plausible  as  it  sounds,  Is 
due  solely  to  the  fact  that,  until  recent  years,  no 
one  realized,  or  even  knew,  what  an  enormously 
large  part  disease  has  played  in  the  death-rate  of  an 
army. 

Just  as  an  Illustration  of  the  real  deadliness  and 
true  perils  of  former  wars  may  be  cited  the  famous 
Thirty  Years'  War.  It  is  estimated  that  during  this 
fierce  and  bloody  strife,  which  ranged  from  the  Medi- 
terranean to  the  Baltic  for  a  full  generation,  the  pop- 


8  THE  DOCTOR  IN  WAR 

ulation  of  Central  Europe  was  reduced  from  nearly 
thirty  million  to  less  than  thirteen  million.  Yet  in 
the  whole  of  this  time  only  about  fifty  important 
battles  were  fought,  whose  total  losses  in  killed  and 
wounded  amounted  to  less  than  half  a  million  men. 

All  the  other  fifteen  million  died  of  disease  and 
famine  and  pestilence.  The  population  of  one  city, 
for  instance,  Oldenburg,  shrank  from  nearly  four  hun- 
dred thousand  to  less  than  seventy  thousand,  and  it 
had  never  been  besieged  nor  had  any  battles  been 
fought  in  its  near  neighborhood. 

When  Napoleon,  having  conquered  Europe,  turned 
his  ambition  and  attention  to  America,  it  was  pes- 
tilence and  not  powder  and  ball  which  barred  his  way 
and  sent  him  down  to  utter  defeat.  He  landed  an 
army  of  fifteen  thousand  men,  splendidly  equipped, 
on  San  Domingo;  they  were  to  seize  the  island, 
build  camps,  and  prepare  a  base  from  which  the 
real  army,  which  was  to  follow  them,  could  conduct 
operations  against  Mexico  and  New  Orleans.  But 
the  fierce  guardian  angels  of  the  tropics,  yellow  fever 
and  malaria,  fell  upon  them,  and  before  the  main 
army  could  start,  there  were  barely  three  thousand 
of  them  left  alive,  and  the  project  was  abandoned 
in  dismay.  Six  months  later  a  couple  of  French  ships 
from  Martinique  came  and  carried  off  the  few  hun- 
dred wretched  survivors. 

On   the  other  side  of   the    Napoleonic  struggle, 


THE  TRIUMPH  OF  THE  DOCTOR  9 

Wellington's  army  in  the  Peninsula  lost  ten  times  as 
many  men  from  disease  as  from  battle,  and  more  in 
one  winter's  encampment  without  any  fighting  than 
inthe  whole  previous  summer's  campaign,  and  this 
represents  about  the  general  ratio  between  diseases 
and  battle  casualties  during  the  last  century. 

Contrary  to  immortal  popular  tradition,  which  is 
usually  wrong,  Napoleon's  ghastly  defeat  in  his  final 
Russian  campaign  was  due  neither  to  the  wasting  of 
the  country  with  fire  and  sword  by  the  Russians  as 
they  retreated  —  for  the  Great  Commander  never  for 
a  moment  attempted  to  live  off  the  country  in  any  of 
his  campaigns,  and  insisted  upon  his  armies  being 
as  well  supplied  with  food  as  they  were  with  ammu- 
nition—  nor  yet  by  "General  January  and  General 
February."  For  in  spite  of  all  the  snow-scene  pic- 
tures which  have  been  painted  of  the  great  retreat, 
remnants  of  his  army  came  back  across  the  Beresina 
early  in  November,  before  the  winter  had  set  in.  The 
real  enemy  that  mowed  down  his  magnificent  army, 
well-fed,  well-clothed,  superbly  equipped  as  it  was, 
was  spotted  typhus,  due  to  lice,  which  raged  through 
its  ranks  like  a  forest  fire. 

By  the  middle  of  the  last  century  the  death-rate 
from  disease  in  war  had  fallen  somewhat,  and  in  the 
American  Civil  War  the  ratio  was  about  five  deaths 
from  disease  to  one  in  battle.  Almost  the  same  ratio 
was  maintained  in  the  Spanish-American  War  and 


10  THE  DOCTOR  IN  WAR 

the  Boer  War  in  spite  of  sanitary  improvements, 
and  the  first  clean  reduction  was  made  in  the  Russo- 
Japanese  War  on  the  Japanese  side.  It  was  here  for 
the  first  time  in  history  that  the  doctor  was  given  real 
power  and  authority  in  an  army  and  the  control  of 
its  sanitary  conditions.  This  brilliant  new  nation  was 
just  innocent  enough  actually  to  put  into  practice 
the  sanitary  principles  which  all  the  European  armies 
had  simply  talked  about,  but  never  dreamed  of  put- 
ting into  force,  with  the  result  that  the  death-rate 
from  disease  fell  to  less  than  half  its  former  amount 
—  that  is,  to  about  two  and  one  half  times  as  great 
as  the  battle-  and  wound-rate. 

This  was  the  record  performance  when  the  present 
war  broke  out,  but  we  have  beaten  it  '*  out  of  sight," 
as  the  Westerners  say,  already.  The  example  o£ 
Japan  has  not  been  wasted ;  the  army  doctor  has  been 
taken  seriously  from  the  start,  and  the  sanitarian 
has  been  given  a  chance  to  make  good  his  claims 
of  prevention,  with  the  cheering  and  almost  incredi- 
ble result  that  the  ratio  of  deaths  from  disease  to 
those  from  bullets  has  been  something  like  double 
reversed,  from  five  to  one,  to  more  than  ten  to  one 
in  the  opposite  direction.  That  is  to  say,  that  in- 
stead of  five  men  dying  of  disease  to  every  one  in 
battle,  in  the  British  army  on  the  Western  front, 
only  one  life  has  been  lost  by  disease  to  every  ten 
in  battle.    In  fact,  disease  as  a  factor  in  the  army 


THE  TRIUMPH  OF  THE  DOCTOR    ii 

death-rate  has  been  almost  wiped  out,  completely  so  in 
the  sense  that  the  amount  of  sickness  in  the  camp  and 
the  deaths  from  disease  at  the  front  have  been  barely 
half  what  they  were  in  barracks  in  times  of  peace. 

This  magnificent  result,  which  amounts  to  the 
saving  of  at  least  four  hundred  thousand  lives  a 
year  on  the  British  Western  front  alone,  has  been 
brought  about  chiefly  in  three  ways,  protection  of  the 
troops  against  infectious  disease  by  the  anti-typhoid 
inoculations  and  other  sanitary  measures,  by  surgi- 
cal skill  and  superb  hospital  organization  enormously 
increasing  the  recovery  rate  from  wounds,  and  by 
the  splendid  way  in  which  the  armies  have  been  fed. 

The  greatest  single  sanitary  triumph  of  the  war 
fias  been  the  wiping  out  of  typhoid  fever  by  means 
of  inoculation  or  vaccination.  This  is  the  real  plague  ^y 
of  armies  in  the  temperate  zone,  as  may  be  illustrated 
by  the  fact  that  it  caused  twice  as  many  deaths  in 
our  American  Civil  War  as  battle  wounds  did,  five 
times  as  many  in  the  Spanish-American  War,  and 
nearly  twice  as  many  in  the  Boer  War.  According 
to  its  former  prevalence  we  should  have  had  three 
hundred  thousand  cases  a  year  on  the  British  West- 
ern front  alone,  while  as  a  matter  of  fact  we  have 
had  only  two  thousand  cases  all  told  during  three 
years  among  nearly  three  million  men. 

That  this  astounding,  almost  incredible  reduction 
has  been  due  to  inoculation  has  been  proved,  first, 


12  THE  DOCTOR  IN  WAR 

by  the  experience  of  our  American  army,  which  has 
scarcely  had  a  death  from  typhoid  in  the  six  years 
since  anti-typhoid  vaccination  was  made  compul- 
sory and  complete;  second,  by  the  fact •* that  both 
the  French,  and,  I  am  happy  to  say,  the  German 
armies  suffered  heavily  from  typhoid  during  the  first 
year  of  the  war,  less  than  ten  per  cent  of  them  being 
protected  by  vaccination  —  as  soon  as  they  set  about 
full  and  complete  vaccination  of  their  forces,  within 
six  months  typhoid  was  almost  at  its  vanishing 
point,  without  any  further  improvement  of  the  sani- 
tary conditions  of  either  army;  third,  by  the  fact 
that  the  typhoid  rate  among  the  small  uninoculated 
minority  of  the  English  troops  is  ten  times  as  great 
as  that  among  the  millions  of  inoculated,  and  the 
death-rate  nearly  forty  times  as  great. 

After  typhoid  the  two  next  deadliest  and  most 
serious  camp  diseases,  diarrhoea  and  dysentery, 
have  been  kept  under  by  scrupulous  watchfulness 
over  the  water-supply,  which  in  many  areas  has  been 
brought  in  pipes,  from  streams  or  reservoirs  many 
miles  distant,  or  filtered  in  sand-beds,  or,  where  this 
was  impossible,  disinfected  by  treating  with  chlorine, 
in  the  form  of  bleaching-powder.  This  last,  if  not 
very  carefully  done,  sometimes  leaves  a  disagreeable 
chemical  taste  in  the  water,  at  which  the  soldiers 
grumble  a  good  deal,  especially  as  it  spoils  the  taste 
of  their  tea,  a  most  vital  and  sensitive  point. 


INOCULATION   AT  SALONICA 


THE  TRIUMPH  OF  THE  DOCTOR    13 

But  in  spite  of  occasional  unpleasantness,  the 
bleaching-powder  in  the  water  is  a  wonderful  pro- 
tection and  safeguard,  as  in  quite  moderate  amounts 
it  will  destroy  all  germs  of  infection  that  may  have 
got  into  the  water,  —  diarrhoea,  dysentery,  typhoid, 
and  cholera,  — •  while  at  the  same  time  it  is  harm- 
less to  the  human  stomach,  and  if  given  sufficient 
time  to  neutralize  and  settle  it  leaves  no  jyrjipleas- 
ant  taste  behind  it. 

But  the  chief  weapon  against  diarrhoea  and  dys- 
entery is  relentless  warfare  against  that  unsuffer- 
able  little  pest  and  carrier  of  pestilences,  the  fly. 
His  "beat"  is  of  the  simplest:  he  visits  the  latrines 
and  loads  up  with  the  germs  of  dysentery,  diarrhoea, 
or  typhoid,  flies  to  the  tents  and  mess  kitchens  and 
distributes  them  broadcast  over  the  food,  both  on 
the  table  and  in  the  larders  and  kitchens,  if  left  un- 
screened. 

In  this  war  no  mercy  has  been  shown  him ;  he  has 
been  cut  off  from  his  supplies  of  infections  by  burn- 
ing in  incinerators  all  human  excreta  and  other  camp 
wastes.  He  has  been  shut  out  of  the  dining-rooms 
and  kitchens  by  screens  or  windows.  He  has  been 
trapped  in  a  thousand  ingenious  ways,  from  sticky 
strings  and  strips  and  papers  to  big  box-traps. 

Last,  and  deadliest  of  all,  he  has  been  deprived  of 
any  possible  place  to  lay  eggs  and  breed  by  burning 
or  carting  out  on  to  the  land  all  manure  heaps,  gar- 
bage dumps,  and  dirt  piles. 


14  THE  DOCTOR  IN  WAR 

So  successful  has  this  warfare  been  that  many  of 
our  army  camps  by  constant  vigilance  have  become 
almost  **  fly  less  towns"  and  some  of  the  most  com- 
plete triumphs  of  this  sort  have  been  won  on  the 
Italian  front  with  its  sub-tropical  climate. 

^  /The  second  great  victory  over  the  death-rate  of 
the  war  has  been  the  wonderful  skill  and  care  of  our 
doctors  and  nurses  in  the  treatment  and  handling  of 
wounds.  In  spite  of  the  fact  that  the  wounds  in  this 
war,  being  eighty  to  ninety  per  cent  from  shell  frag- 
ments, have  been  the  ghastliest,  the  most  horribly 
lacerated,  and  the  most  vilely  infected  ever  known, 
so  that  we  had  to  go  back  to  the  beginning  and 
start  over  again,  the  team-work  between  surgeon, 

i  ambulance,  and  nurse  has  been  so  superb  that  of  the 
wounded  who  live  long  enough  to  be  carried  down  to 
the  ambulance,  ninety  per  cent  recover,  of  those 
who  survive  to  reach  the  Casualty  Clearing  Station, 
ninety-five  per  cent  recover;  and  of  those  who  reach 

^the  Base  Hospital,  ninety-eight  per  cent  recove?). 
There  are  hospitals  in  England  which  have  han- 
dled six,  eight,  ten  thousand  successive  cases  with 
only  about  three  or  four  deaths   in  the  thousand. 

\  Never  was  such  a  recovery-rate  known  in  the  world 
before.   In  the  olden  days  fifty  per  cent  was  con- 

i  sidered  an  excellent  recovery-rate,  while  as  recently 

fas  the  American  Civil  War,  the  death-rate  among 

I  the  wounded  was  at  least   twenty  per  cent,  and 


THE  TRIUMPH  OF  THE  DOCTOR     15 

often,  when  hospital  gangrene  broke  out,  rose  to'^ 
forty  and  even  sixty  per  cent.  When  it  is  further 
stated  that  of  all  the  wounded  eighty  per  cent  are 
able  to  return  to  the  front  within  a  little  over  forty 
days,  it  will  be  seen  what  a  powerful  and  immensely 
important  factor  in  keeping  up  the  strength  of  the 
army  the  doctor  is  to-day.  Even  the  haughtiest  line 
officer  must  admit  that  he  is  entitled  to  some  au- 
thority and  a  voice  in  the  direction  of  army  affairs. 

This  wonderful  result  and  triumph  of  surgery  has 
been  brought  about  in  face  of  the  greatest  difficulties 
from  the  beginning.  For  twenty  years  past  the  wounds 
of  modem  war  have  been  becoming  less  deadly,  be- 
cause less  infected.  So  tremendous  is  the  pressure 
and  friction  upon  the  high-velocity  bullet  as  it  is 
driven  through  the  barrel  of  the  modern  rifle,  that 
it  is  practically  sterilized  by  heat  and  enters  the 
body  of  its  victim  germ-free.  Furthermore,  by  its 
whirling  motion  and  pointed  tip  it  makes  a  very 
small  wound  with  an  almost  "seared"  track,  which 
is  followed  by  very  little  hemorrhage  unless  it  has 
struck  a  large  artery. 

^  I  have  seen  bullet  wounds  on  the  Western  front 
in  this  war  which  had  gone  completely  through  an 
arm  or  a  leg  without  hitting  the  bone,  and  were 
practically  healed,  with  only  a  round  dry  scab  at 
each  end  to  show  for  them,  inside  of  eight  or  ten  days. 

But,  alas,  bullet  wounds  have  played  an  aston- 


i6  THE  DOCTOR  IN  WAR 

ishingly  small  part  of  the  casualties  of  this  war;  from 
the  beginning  eighty-five  per  cent  of  all  the  wounds 
were  from  shell  fragments,  and  this  has  since  risen 
to  ninety  and  ninety-five  per  cent.  And  a  shell 
wound  is  everything  that  a  wound  should  not  be  — 
huge,  ragged,  irregular,  like  the  jagged  and  saw- 
tooth-edged fragments  which  produce  it,  and  worst 
of  all  horribly  infected.  This  is  due  to  the  fact  that 
most  shells  not  only  strike  the  ground,  but  bury 
themselves  somewhat  before  they  explode,  and 
hence  every  sharp-edged  fragment  comes  up  simply 
loaded  with  dirt  and  swarming  with  all  the  germs 
and  filth  that  may  be  in  the  soil. 

As  the  fighting  in  Belgium  and  northern  France 
has  been  over  the  most  intensively  cultivated  and 
richly  fertilized  soil  in  Europe,  all  the  germs  which 
exist  in  stable  manure  and  fertilizers  of  all  sorts 
have  been  hurled  into  the  utmost  depths  and  remot- 
est corners  of  every  wound.  Unfortunately  two  of 
the  deadliest  germs  known  to  surgery,  the  tetanus 
bacillus  and  the  bacillus  of  gas  gangrene,  have  their 
normal  habitat  in  the  intestines  of  the  horse;  there- 
fore there  was  a  terrific  outbreak  of  both  tetanus  and 
gas  gangrene  in  the  very  first  months  of  the  war. 

The  tetanus  or  lockjaw  was  quickly  brought  down 
by  the  use  of  the  tetanus  anti- toxin,  and  the  gas 
gangrene  was  successfully  attacked  by  new  methods 
of  operations  and  irrigating  the  wounds;  but  both 


THE  TRIUMPH  OF  THE  DOCTOR    17 

dangers  still  hang  over  us  and  can  be  avoided  only 
by  sleepless  vigilance. 

Another  service  of  great  value  to  the  war  strength 
of  the  nation  has  been  rendered  by  the  doctor  and 
the  sanitarian  which,  although  less  dramatic  and  at- 
tracting less  attention  than  that  accomplished  upon 
the  field  of  battle,  is  almost  equal  to  it  in  impor- 
tance. This  is  the  persistent,  tireless,  successful  war 
waged  by  our  medical  officers  of  health,  our  medical 
inspectors  of  factories  and  industries,  and  the  vari- 
ous organizations  for  fighting  tuberculosis  and  low- 
ering the  child  death-rate.  We  have  become,  per- 
haps, accustomed  to  look  upon  this  sort  of  vigilance 
as  a  matter  of  course  and  even  inclined  to  be  a  little 
skeptical  as  to  the  reality  of  the  dangers  which  we 
have  avoided  through  its  exercise. 

But  the  strain  and  stress  of  war  have  both  in- 
creased its  powers  and  brought  its  results  into  high 
relief,  in  the  gratifying  and  encouraging  fact  that  in 
spite  of  the  absence  of  wage-earners,  in  spite  of  the 
anxiety  and  grief  and  hardship  inseparably  con- 
nected with  war,  in  spite  of  the  scarcity  of  some  and 
the  high  prices  of  all  classes  of  food,  the  English 
civilian  death-rate  and  disease-rate  have  not  only  not 
increased  during  the  war,  but  have  actually  been 
decreased  and  brought  down  to  the  lowest  figure  in 
history. 

Such  excellent  and  watchful  care  has  been  taken 


i8  THE  DOCTOR  IN  WAR 

of  the  feeding,  the  hours  of  work,  and  the  conditions 
of  labor  of  the  workers,  such  special  efforts  have 
been  put  forth  to  safeguard  the  lives  and  improve 
the  food  and  health  surroundings  of  young  children, 
that  there  is  good  ground  for  the  statement  that 
England  is  actually  saving  life  at  home  faster  than 
it  is  being  wasted  upon  the  field  of  battle  abroad.  So 
that  the  population  of  Great  Britain  is  not  only  not 
diminishing,  but  actually  slightly  increasing  in  spite 
of  the  war.  In  fact,  incredible  as  it  may  sound,  the 
total  death-rate,  both  military  and  civil  during  the 
last  three  years,  is  very  little  higher  than  what  would 
have  been  considered  an  average  one  in  the  civilized 
countries  of  Europe  sixty  or  seventy  years  ago.'^ 

^  \  This  successful  fight  against  disease  and  death  at 

\  home  has  been  greatly  helped  by  one  of  the  curious 
compensations  of  this  war,  and  that  is  the  extent 
to  which  it  is  a  war  of  huge  cannon  and  high  explo- 

\  sives,  of  engines  of  destruction,  and  of  machinery 
in  every  imaginable  form.  This  means  an  immense 
demand  for  factory  production  of  every  sort  at 
home,  with  wages  to  match;  indeed,  as  Mr.  Lloyd 
George  has  stated  in  one  of  his  speeches,  it  takes 
four  men  and  three  women  in  factories  and  on  the 
I  railroads  at  home  to  support  and  supply  one  fighting 
I  man  on  the  line  of  battle. 
j     This  means  that  the  wealth  of  the  country  has 

/been  distributed  and  is  being  distributed  increas- 


THE  TRIUMPH  OF  THE  DOCTOR    19 

ingly  among  those  who  need  and  deserve  it  most, 
that  the  women  and  children  and  men  unfit  for  mili- 
tary service  at  home,  instead  of  being  left  unem- 
ployed and  starving,  have  had  abundance  of  work 
at  the  highest  wages  ever  known.  Although  food  is 
high,  wages  are  still  higher  and  the  net  result  of  it 
all  is  that  never  were  the  great  eighty-five  per  cent 
mass  of  the  people,  the  laboring  classes,  so  well  fed, 
so  well  clothed,  so  well  housed  and  sanitated,  and  in 
such  excellent  physical  condition  as  they  are  to-day. 
U  What  is  almost  more  gratifying,  the  ruthless  pres- 
sure and  emergencies  of  war  have  revealed  the  fact, 
which  we  doctors  have  been  preaching  for  years, 
that  the  better  the  workers  are  fed  and  housed,  the 
shorter,  within  reasonable  limits,  their  hours  of  em- 
ployment, the  higher  their  wages,  and  the  more  ideal 
the  sanitary  conditions  under  which  they  work,  the 
more  and  better  work  they  will  do,  and  the  larger 
profits  they  will  earn  for  their  employers.  In  fact, 
the  interests  of  employers  and  employed  are  not 
different  and  hostile,  but  one  and  identical,  and  the 
demonstration  of  this  fact  has  brought  a  new  spirit 
of  friendliness  and  mutual  interest  and  regard  for 
each  other's  welfare  into  the  industrial  world,  which 
will  never  die  out,  but  will  survive  long  after  the  war 
is  over  and  half  forgotten. 

One  of  the  most  cheering  and  encouraging  aspects 
of  a  visit  to  the  front  and  the  actual  fighting  line 


-^ 


20  THE  DOCTOR  IN  WAR 

is  the  sense  of  a  whole-souled  devotion  to  a  common 
end  and  of  a  real  community  of  interest  and  brother- 
hood of  helpfulness,  among  tens  and  hundreds  of 
thousands  of  men.  It  is  a  real  Utopia,  a  genuine 
democracy,  with  every  effort  devoted  to  a  common 
end  and  the  common  welfare.  If  this  spirit,  return- 
ing from  abroad,  shall  fuse  with  the  new  spirit  at 
home,  as  it  certainly  will,  the  world  will  be  lifted  to 
a  higher  plane  of  fairness,  of  kindliness,  and  of  jus- 
tice, and  even  the  bitter  and  pitiful  losses  of  this 
deplorable  war  may  prove  to  have  won  an  adequate 
reward. 


II 

,  THE  REAL  PERILS  OF  WAR 

FROM  the  earliest  dawn  of  consciousness  the 
three  most  dreaded  perils  of  the  race  have  ever 
been  war,  pestilence,  and  famine.  And  the  greatest 
of  these  is  war.  Every  age  has  echoed  the  sobbing 
chant  of  the  Litany:  "From  battle  and  murder,  and 
from  sudden  death,  Good  Lord,  deliver  us." 

The  march  of  civilization  has  been  one  long,  bit- 
ter fight  against  this  devil's  trinity,  and  up  to  about 
a  century  ago  with  indifferent  success.  Then  the 
harnessing  of  steam  and  the  birth  of  science  began 
to  make  man  the  master  of  the  elements  and  the 
gods,  instead  of  their  football;  and  within  fifty  years 
more  headway  was  made  against  these  three  Furies 
than  in  fifty  centuries  before.  During  the  next  half- 
century  —  the  past  fifty  years  —  this  has  been  sim- 
ply multiplied  by  five.  -  ^ 

Famine  was  the  first  of  the  hereditary  curses  to 
go  down  and  be  swept  off  the  earth.  This  does  not 
sound  remarkable  to  us  now,  because  we  have  for- 
gotten that  bitter  starvation  and  death  by  hunger 
were  once  parts  of  the  regular  process  of  the  seasons. 
Famine  occurred  every  winter  among  savages,  every 
three  to  five  years  among  semi-civilized  peoples,  and, 


22  THE  DOCTOR  IN  WAR 

on  an  average,  about  every  fifteen  years  among  the 
most  highly  civiHzed  nations,  until  about  seventy- 
five  years  ago. 

It  was  the  deliberate  and  carefully  considered 
statement  of  one  of  the  greatest  English  economists, 
sixty  years  ago,  that  four  fifths  of  the  people  of  Great 
Britain  never  in  all  their  lives  had  had  as  much  as 
they  could  eat,  and  never  were  comfortably  warm 
from  November  to  April.  Now  famine  —  thanks  to 
our  steam- won  conquest  of  empires  of  virgin  soil  — 
is  a  thing  unheard  of  and  incredible  among  civilized 
races.  The  last  flickering  horror  of  it  in  western 
Europe  was  the  year  of  the  potato  blight  in  Ireland, 
and,  in  eastern  Europe,  the  year  of  the  corn  mildew 
in  Russia;  though  like  the  rest  of  the  dead  and  half- 
forgotten  plagues  of  the  past,  famine  has  again  **  res- 
urrected "  to  play  a  part  in  this  war  and  has  actually 
claimed  more  people  in  Poland,  Russia,  Armenia, 
and  Serbia  than  the  sword  or  the  shell. 

The  next  to  weaken  and  give  ground  was  the 
plague  of  the  pestilence.  That  winning  campaign  is 
such  recent  history  as  to  be  within  the  memory  of 
all;  indeed,  many  of  us  have  borne  or  are  still  bear- 
ing a  musket  in  the  ranks.  The  victory  is  more  than 
half- won  already ;  and  the  end  —  the  sweeping  away 
of  all  infectious  disease  and  the  bringing  of  two  thirds 
of  all  deaths  under  two  great  causes,  accident  and  old 
age  —  is  in  sight. 


THE  REAL  PERILS  OF  WAR         23 

What  have  we  accomplished  against  the  last  gteat 
enemy  of  humanity  —  war?  From  some  points  of 
view,  painfully  little.  If  we  look  at  the  so-called 
leaders  of  civilization  piling  up  armament  on  arma- 
ment ;  loading  war  taxes  on  the  backs  of  the  peasant 
and  the  laborer  until  they  groan  beneath  the  bur- 
den; matching  regiment  against  regiment  and  dread- 
nought against  dreadnought  in  insane  rivalry,  which 
has  finally  burst  the  bounds  of  civilization  and  is 
deluging  Europe  with  blood,  we  are  ready  to  cry  in 
despair  that  our  boasted  progress  has  been  but  mill- 
ing in  a  circle,  and  to  echo  Browning's  despairing 
apostrophe  to  the  Prince  of  Peace :  — 

"  Whose  sad  face  on  the  cross  sees  only  this, 
After  the  passion  of  a  thousand  years." 

Plunged  at  a  moment's  warning,  by  the  mad  van- 
ity and  insensate  jealousy  of  a  few  hereditary  lead- 
ers, into  what  bids  fair  to  be  the  bloodiest  war  of  all 
history,  it  hardly  looks  as  though  we  could  boast  our- 
selves of  any  real  superiority  over  the  Huron- Iro- 
quois Confederacy  or  the  age  of  Attila  and  Jenghiz 
Khan. 

When  we  come  to  look  at  the  actual  facts  and  con- 
ditions of  war,  however,  the  manner  in  which  it  is 
waged  and  the  circumstances  under  which  its  grim 
purposes  are  carried  out,  we  find  considerable  ground 
for  encouragement.  War,  of  course,  is,  and  in  the 
nature  of  it  always  will  be,  exactly  what  General 


24  THE  DOCTOR  IN  WAR 

Sherman  called  It;  but  even  the  cheerful  pastime  of 
slaughtering  our  fellow  men  has  in  the  most  recent 
wars  been  carried  on  with  smaller  loss  of  life  and 
less  suffering  and  hardship,  both  to  the  actual  com- 
batants and  to  the  non-combatants  in  whose  ter- 
ritories the  war  has  been  waged. 

It  has  taken  a  smaller  percentage  of  dead  and 
wounded  to  decide  the  fate  of  a  battle.  The  actual 
losses  in  battle  have  grown  steadily  less  in  each  suc- 
cessive century,  and  the  total  death-rate  of  the  most 
recent  wars  has  been  barely  a  fifth  of  what  it  was 
a  century  ago.  The  average  death-rate  of  the  first 
three  great  wars  of  the  past  century  —  the  Napole- 
onic, the  Mexican,  and  the  Crimean  —  was  12.5  per 
cent  a  year;  that  of  the  last  three  wars  —  the  Span- 
ish-American, the  Boer,  and  the  Russo-Japanese  — 
was  4.8  per  cent;  that  of  the  present  so  far  is  about 
3  per  cent. 

How  has  this  unexpected  change  and  remarkable 
improvement  been  brought  about?  At  first  sight  the 
fact  itself  will  probably  be  called  sharply  in  ques- 
tion and  seem  almost  incredible.  The  burden  of  the 
song  of  the  modern  advocates  of  peace  is  that  ow- 
ing to  the  fiendishly  ingenious  improvements  which 
have  been  made  by  science  in  our  implements  of 
slaughter  —  dynamite  shells,  rifles  that  kill  at  ten 
times  the  old  range,  cannon  that  hurl  a  ton  at  a  shot, 
Maxims  and  Nordenfelts  that  pour  bullets  like  a 


THE  REAL  PERILS  OF  WAR        25 

stream  from  a  fire  hose  —  war  has  become  so  hor- 
ribly deadly,  so  cataclysmic  in  its  destructiveness, 
that  human  spirit  and  flesh  and  blood  can  no  longer 
endure  it. 

Here  we  go  at  it  since  1914,  however,  as  coolly  and 
recklessly,  though  not  quite  so  cheerfully  and  light- 
heartedly,  as  they  did  in  1419.  The  reason  is  that 
the  same  brain  which  invented  these  killing-machines 
has  to  some  extent  devised  means  for  neutralizing 
or  evading  their  deadly  effects.  A  battle  may  be 
fought  to-day  with  high-velocity  bullets,  the  latest 
field  artillery,  lyddite  or  cordite  shells,  dynamite 
mines,  and  pom-pom  machine  guns  capable  of  mow- 
ing their  way  through  the  trunk  of  a  tree,  and  de- 
cided with  less  than  half  the  loss  of  life  that  it  cost 
in  the  days  of  the  arrow,  the  javelin,  and  the  spear, 
or  in  those  of  the  flintlock  and  the  sabre. 

That  this  striking  decrease  in  the  fatality  of  war 
has  actually  occurred  is  as  abundantly  attested  as 
any  fact  of  history ;  for,  since  the  time  when  anything 
approaching  accurate  records  have  been  kept  of  battle 
losses,  each  century  has  shown  a  steady  and  constant 
lowering  of  the  number  killed  and  wounded  in  pro- 
portion to  the  forces  engaged.  But  the  history  of 
the  battles  now  being  fought  has  still  to  be  written. 

In  the  days  of  Agincourt,  for  instance,  when  the 
issue  was  decided  by  showers  of  arrows  at  fifty  paces, 
or  by  sword,  spear,  and  battle-axe,  breast  to  breast 


26  THE  DOCTOR  IN  WAR 

and  hand  to  hand,  the  average  loss  in  killed  and 
wounded  was  anywhere  from  fifteen  to  thirty  per 
cent  of  the  forces  engaged;  in  fact,  in  those  days  the 
soldier  who  came  out  of  a  seriously  disputed  battle 
between  anything  like  equal  forces  without  some 
kind  of  wound  was  looked  on  with  considerable  sus- 
picion as  to  his  courage  or  his  fidelity. 

After  the  introduction  of  gunpowder,  —  which, 
paradoxical  as  it  may  seem,  has  been  one  of  the 
great  life-saving  forces  of  history;  first,  by  deciding 
battles  at  long  range;  second,  by  breaking  up  and 
wiping  out  of  existence  the  baron's  castle  and  the 
walled  and  fortified  town;  and  third,  by  making 
civilization  permanent,  eternally  superior  to  savage 
attack,  Goth,  Vandal,  or  Hun,  —  though  much 
larger  armies  were  brought  into  the  field  and  cam- 
paigns conducted  on  a  far  more  extensive  scale,  the 
actual  percentage  of  losses  fell  distinctly. 

By  the  time  the  Napoleonic  wars  were  reached  the 
death-rate  in  war  from  all  causes  had  fallen  to  about 
one  hundred  and  twenty-five  per  thousand  a  year, 
or  about  twelve  per  cent.  In  our  own  Civil  War  it 
fell  to  ten  per  cent.  The  Sedan  campaign  cost  the 
German  army  only  eight  per  cent  of  its  three  quarters 
of  a  million  men;  while  our  Spanish- American  War 
and  England's  Boer  War  reached  the  low-water 
mark,  with  barely  three  and  four  per  cent  of  loss 
respectively. 


THE  REAL  PERILS  OF  WAR        27 

As  to  the  cause  of  this  gratifying  reduction  in  war 
fatalities,  several  influences  have  been  at  work.  One 
of  the  most  obvious  has  been  that  the  invention  of 
gunpowder  and  the  improvement  of  rifles  and  artil- 
lery, with  such  enormous  increase  in  their  range  of 
death-dealing,  has  steadily  forced  more  and  more  of 
the  fighting  to  be  carried  on  at  long  range. 

The  net  result  of  this  has  been  that  not  nearly  so 
many  men  are  actually  hit  as  in  the  days  of  old 
point-blank  firing  by  platoons;  that  as  a  battle  be- 
comes a  long-range  duel,  directed  by  field-glasses, 
heliographs,  and  telephones,  its  fate  is  decided  more 
and  more  by  maneuvers  such  as  surrounding  a  force 
or  cutting  it  off  from  its  base  than  by  actual  sacri- 
fice of  life  or  by  weight  of  numbers  in  a  bayonet 
charge.  That  both  these  influences  are  at  work  and 
have  operated  in  this  direction  is  unanimously  ad- 
mitted by  all  military  experts  and  supported  by  con- 
vincing proof. 

In  the  first  place,  the  weight  in  lead  or  shells  which 
has  to  be  fired  from  rifles  or  cannon  in  order  to  kill 
a  single  soldier  has  markedly  increased  within  the 
last  fifty  years.  The  old  saying  used  to  be  that  every 
bullet  had  its  billet.  Then,  twenty  or  thirty  years  ago, 
this  was  changed  to  the  statement  that  for  every  man 
killed  his  own  weight  of  lead  or  iron  in  the  shape  of 
bullets  or  shells  had  been  fired.  In  the  last  official 
slaughter  but  one  —  the  Balkan  War  —  a  Belgian 


28  THE  DOCTOR  IN  WAR 

surgeon,  Dr.  Laurent,  who  served  with  the  Bulgarian 
army,  calculated  the  actual  expenditure  of  ammuni- 
tion compared  with  the  number  of  Turks  killed,  and 
found  that  there  were  one  hundred  and  ten  rifle  balls 
and  ninety  shells  and  shrapnel  fired  for  each  dead 
Moslem.  While  in  this  present  war  it  is  estimated  to 
take  nearly  two  tons  of  shells  and  explosives  to  kill 
one  enemy  soldier. 

The  other  most  important  change,  due  to  the  new 
methods  of  fighting  since  the  use  of  gunpowder  and 
long-range  weapons,  was  that  in  the  old  days,  when 
battles  were  decided  by  hand-to-hand  fighting,  the 
victors  were  literally  right  on  top  of  the  vanquished 
the  moment  the  tide  turned  and  the  retreat  began; 
and  only  superior  fleetness  of  foot  or  length  of  wind 
could  save  a  very  large  percentage  of  the  beaten  troops 
from  slaughter,  maiming,  or  slavery. 

By  far  the  most  important  and  influential  factor, 
however,  in  denaturing  and  taking  the  curse  off  war 
has  been  the  advance  in  medical  science.  This  may 
seem,  at  first  sight,  an  extraordinary  if  not  extrav- 
agant statement;  for  even  the  most  enthusiastic 
champion  of  medicine  will  admit  that,  with  all  our 
progress,  we  have  never  been  able  to  raise  the  dead, 
or  do  much  to  restore  the  man  who  has  had  his  head 
taken  off  by  a  cannon  ball  or  been  blown  to  pieces 
by  a  shell.  Doctors  may  cure  diseases,  but  they  can- 
not do  much  to  remedy  sudden  death. 


THE  REAL  PERILS  OF  WAR        29 

This  incredulity,  however,  is  simply  due  to  a  mis- 
understanding of  the  facts.  Naturally  enough,  since 
the  main  business  of  war  is  the  slaughtering  or  dis- 
abling of  the  enemy,  we  have  taken  it  for  granted 
that  the  chief  risk  of  warfare  is  that  of  death  in  bat- 
tle. As  a  matter  of  fact,  battle  is  one  of  the  least  of 
the  perils  of  war;  for  until  within  the  last  forty  or 
fifty  years  the  loss  in  battle  and  by  wounds  has  never 
been  more  than  a  fifth  as  great  as  the  loss  resulting 
from  disease.  In  Napoleon^s  Peninsular  campaigns, 
for  instance,  of  four  hundred  and  sixty  thousand  men 
lost,  only  sixty  thousand  fell  in  battle  —  that  is  to 
say,  in  bloody  war  disease  caused  from  five  to  twenty- 
five  times  as  many  deaths  as  the  sword  or  the  bullet. 
And  the  real  horror  of  war  is  fever.  The  whimsical 
paradox  holds  that,  by  cold  figures,  soldiers  are  safer 
on  the  battle-field  than  in  camp,  though  not  in  pro- 
portion to  the  time  spent  there. 

Four  fifths  of  the  slaughter  in  war  has  in  the  past 
been  due  to  disease,  and  at  least  ninety  per  cent  of  that 
disease  is  preventable;  in  fact,  it  has  already  been 
prevented  in  one  epoch-making  modern  instance  — 
among  the  Japanese  in  the  Russo-Japanese  War,  where 
the  death-rate  from  disease  was  barely  two  per  cent. 
Improvements  and  progress  since  then  have  put  us  in 
a  position  to  cut  in  two  even  that  low  rate  and  reduce 
it  to  one  per  cent  a  year,  or  the  same  as  that  of  a  simi- 
lar body  of  men  engaged  in  peaceful  occupations. 


30  THE  DOCTOR  IN  WAR 

Even  the  direct  and  necessary  fatality  from  deaths 
in  battle  and  from  wounds  has  been  tremendously 
reduced  by  medical  science.  Though  those  who  are 
killed  outright,  or  are  so  terribly  torn  and  mangled 
that  they  die  from  shock  or  hemorrhage  within  a 
few  hours,  are,  alas!  beyond  our  skill,  these  consti- 
tute barely  half  of  the  total  deaths  from  battle;  in 
fact,  when  we  first  begin  to  study  the  figures  we  get 
the  gruesome  impression  that  war  is  becoming  dead- 
lier, because  a  so  much  larger  percentage  of  the  lost 
are  killed  outright  or  die  on  the  field. 

In  an  earlier  day  the  proportion  used  to  run:  five 
thousand  killed  in  battle;  seven,  ten,  or  twelve  thou- 
sand died  of  wounds.  About  fifty  years  ago  the  pro- 
portions became  about  even.  In  our  Civil  War  the 
deaths  on  the  battle-fields  forged  ahead  —  namely, 
sixty-seven  thousand,  while  only  forty- three  thou- 
sand died  of  wounds.  In  the  Franco-Prussian  War, 
on  the  German  side  seventeen  thousand  were  killed 
outright  and  eleven  thousand  died  of  wounds;  while 
in  the  Russo-Japanese  War  forty-seven  thousand 
Japanese  fell  in  battle  and  only  eleven  thousand  died 
of  wounds,  making  the  proportions  over  four  to  one. 
In  the  first  Balkan  War  the  figures  ran  thirty  thou- 
sand to  twelve  thousand. 

The  briefest  hospital  experience  will  explain  this 
paradox.  There  are  as  many  wounded  in  proportion 
to  the  killed  outright  as  before;  only,  instead  of  from 


THE  REAL  PERILS  OF  WAR        31 

twenty  to  fifty  per  cent  of  the  wounded  dying  from 
their  wounds,  as  in  the  old  days  of  hospital  gangrene, 
tetanus,  and  erysipelas,  in  these  days  of  antiseptic 
surgery,  from  ninety  to  ninety-five  per  cent  of  the 
wounded  recover. 

To  put  it  briefly,  judging  from  the  statistics  of 
recent  warfare  the  chances  of  the  modern  soldier's 
being  killed  in  battle  in  a  year's  campaign  have  been 
reduced  to  about  one  in  thirty;  his  chances  of  dying 
of  wounds  received  in  battle  to  about  one  in  sixty; 
his  chances  of  dying  of  disease  to  less  than  one  in 
a  hundred.  How  this  compares  with  an  earlier  day 
may  be  illustrated  by  one  concrete  average  instance : 
In  the  Russo-Turkish  War  of  1828,  out  of  an  army 
of  one  hundred  and  fifteen  thousand  Russians  who 
crossed  the  border,  not  more  than  fifteen  thousand 
ever  returned  to  Russia,  after  serving  in  only  two 
campaigns. 

One  of  the  interesting  by-products,  as  the  chem- 
ists say,  of  this  transformation  of  warfare  is  the 
striking  diminution  in  suffering,  agony,  and  discom- 
fort of  those  who  actually  become  food  for  powder. 

It  is,  of  course,  obvious  that  those  who  are  killed 
instantly  on  the  field  of  battle  mercifully  suffer  no 
pain;  and  consequently  the  larger  the  percentage  of 
such  deaths  in  the  total  number  of  fatalities  the 
less  the  actual  agony  and  suffering  endured.  The 
old  prayer  to  be  delivered  from  sudden  death  had  it 


32  THE  DOCTOR  IN  WAR 

wrong.  It  is  from  every  point  of  view  the  best  form 
of  death  there  is  —  though  we  are  not  anxious  to 
have  Gabriel  call  us  any  earlier  than  necessary. 

In  the  second  place,  the  greater  part  of  the  pain 
and  suffering  and  agony  produced  by  wounds  comes 
not  at  the  time  of  their  infliction,  or  within  six  or 
eight  hours  thereafter,  but  when  they  begin  to  fester 
and  suppurate  and  inflame.  This  we  used  to  call, 
in  our  innocence,  the  process  of  healing;  now  we 
know  it  to  be  the  onset  of  infection. 

It  is  difficult  to  make  any  one  who  has  not  had 
actual  experience,  either  as  a  surgeon  or  as  a  patient, 
believe  it;  but  it  is,  nevertheless,  a  merciful  fact 
that  the  severest  and  most  serious  injuries  or  wounds 
often  cause  astonishingly  little  pain  at  the  time  of 
their  infliction.  A  broken  leg  or  a  broken  arm,  for  in- 
stance, eight  times  out  of  ten  causes  little  or  no  pain. 
Thousands  of  cases  are  on  record  where  a  man  has 
had  his  leg  broken  in  a  railroad  wreck,  or  runaway 
accident,  or  factory  smash,  and  has  never  known 
that  it  was  broken  until  he  tried  to  move  it  or  to 
walk  on  it.  The  same  is  true  of  bullet  wounds.  Many 
a  soldier  in  a  bayonet  charge  has  suddenly  plunged 
headlong,  feeling  as  though  one  leg  had  gone  numb, 
or  supposing  he  had  tripped  or  stumbled;  and  when 
he  tried  to  rise  has  found  the  bone  shattered  by  a 
bullet. 

On  the  other  hand,  many  wounds,  not  at  all  dan- 


THE  REAL  PERILS  OF  WAR        33 

gerous  to  life  or  even  temporarily  disabling,  are 
agonizingly  painful  simply  because  the  injury  has 
been  just  severe  enough  to  tear  or  graze  or  lacerate 
the  nerves,  but  not  sufficiently  crushing  or  stunning 
to  numb  and  paralyze  them.  This  is  not,  by  any 
means,  to  say  that  to  be  wounded  in  battle  is  a  tri- 
fling and  painless  amusement;  but  only  that  a  con- 
siderable percentage  —  from  fifty  to  seventy  would 
not  be  too  large  an  estimate  —  of  the  more  serious 
wounds,  and  a  still  higher  percentage  of  the  mortal 
ones,  are  attended  with  comparatively  little  serious 
or  agonizing  pain. 

In  war,  as  in  the  sick-room,  the  ability  to  feel  acute 
pain  is  a  sign  of  life  and  resisting  power;  and  so  long 
as  our  patients  are  actually  afraid  they  are  going  to 
die,  or  are  making  audible  complaint  of  their  suffer- 
ings, we  seldom  feel  uneasy  about  the  outcome.  It 
is  when  they  begin  to  lose  interest  in  whether  they  are 
going  to  get  better  or  not,  or  lie  wide-eyed,  without 
uttering  a  word  or  making  a  sound,  that  we  feel  the 
situation  is  serious.  Either  disease  or  wounds  that 
are  serious  enough  to  prove  fatal  or  to  put  life  seri- 
ously in  peril  carry,  for  the  most  part,  —  most  mer- 
cifully, —  their  own  anaesthetics  with  them,  by  either 
crushing  or  poisoning  the  nerve-trunks  until  they 
are  unable  to  report  pain. 

Should  a  bullet  or  bayonet  wound  prove  fatal,  the 
nerves  never  recover  consciousness,  so  to  speak;  but 


34  THE  DOCTOR  IN  WAR 

in  those  of  lighter  character,  from  which  the  patient 
is  able  to  rally  as  soon  as  strength  and  consciousness 
begin  to  return,  the  nerve-trunks  wake  up  with  the 
rest  of  the  body,  and  a  period  of  intense  boring  or 
burning  pain  follows.  This,  however,  can  usually  be 
kept  fairly  within  bounds  by  an  opiate  and  in  any 
severity  lasts  only  until  the  tissues  begin  to  heal 
—  that  is  to  say,  anywhere  from  six  to  forty-eight 
hours. 

The  time  when  wounds  really  begin  to  hurt  is 
from  thirty-six  to  seventy-two  hours  after  their  in- 
fliction, when  suppuration  or  inflammation  sets  in. 
This  swelling  and  burning  and  throbbing  with  a 
profuse  outpouring  of  matter  or  pus  —  pus  lauda- 
hiUj  *'  praiseworthy  matter,"  as  it  was  called  —  used 
to  be  regarded  as  part  of  the  regular  process  of  heal- 
ing; but  since  the  days  of  Lister  we  have  discovered 
that,  instead  of  being  a  part  of  healing,  it  is  a  purely 
mischievous  and  injurious  process  due  solely  to  in- 
fection with  one  or  the  other  of  the  so-called  pyogenic 
or  septic  germs,  usually  streptococci  or  staphylo- 
cocci. Keep  these  out  of  the  wound,  and  inflamma- 
tion, with  its  throbbing  agony  and  fever  and  horrible 
discharges,  will  be  entirely  avoided. 

Easily  two  thirds  of  the  pain  and  suffering  en- 
dured by  the  wounded  in  war  is  not  due  to  the  wounds 
themselves  or  to  the  process  of  healing,  but  to  sup- 
puration and  infection;  and  all  this  has  been  wiped 


THE  REAL  PERILS  OF  WAR        35 

out  by  antiseptic  surgery.  What  military  hospitals 
were  like  in  the  pre-antiseptic  days  beggared  de- 
scription, and  can  hardly  be  imagined  even,  let  alone 
believed,  at  the  present  day. 

Marlborough's  surgeon  in  the  famous  Blenheim 
campaign  declared  that  hospitals  were  the  most  im- 
portant cause  of  death.  And  a  famous  French  sur- 
geon in  1 74 1  declared  that  he  had  known  vastly  more 
men  to  die  in  the  hospitals  from  lack  of  care  than  to 
lose  their  lives  in  combat;  and  that  "hospitals  are 
an  unfathomable  gulf;  the  source  of  their  horrors 
appears  to  be  inexhaustible."  Two  patients  in  each 
bed  was  the  rule  and  often  three  or  even  four.  The 
hospitals  were  literally  breeding-places  for  disease. 
The  deadly  typhus  fever  used  to  be  known  as  "  hos- 
pital fever";  while  typhoid,  dysentery,  erysipelas, 
and  gangrene  fairly  ran  riot  in  them.  Browning's 
characterization  of  the  mediaeval  hospital,  as  "  that 
good  house  that  helps  the  poor  to  die,"  was  painfully 
accurate. 

I'  Even  as  late  as  our  Civil  War,  when  the  dreaded 
hospital  gangrene  once  put  in  an  appearance  in  a 
ward  it  was  a  sentence  of  death  to  be  sent  into  that 
ward  with  an  open  wound;  and  in  some  instances 
from  forty  to  sixty  per  cent  of  all  the  inmates  actu- 
ally died.  Up  to,  and,  indeed,  during,  the  Napoleonic 
wars  anywhere  from  twenty  to  sixty  per  cent  of  the 
wounded  died.    To-day  any  army  medical  service 


36  THE  DOCTOR  IN  WAR 

that  loses  more  than  five  or  six  per  cent  of  its  wounded 
considers  itself  disgraced. 

The  methods  by  which  these  wonderful  savings  of 
life  and  suffering  have  been  accomplished,  the  tri- 
umphs of_  antiseptic  surgery,  need  no  description; 
for  they  are  common  knowledge,  as  well  as  one  of 
the  wonders  of  the  age.  The  strictest  and  most  scru- 
pulous cleanliness,  the  boiling  of  instruments,  and 
cleaning  of  surgeons'  and  nurses'  hands  —  these  are 
practiced  in  every  hospital  and  taught  to  the  rising 
generation  in  our  schools. 

The  importance  of  one  point,  however,  is  not  yet 
fully  recognized,  and  that  is  the  part  played  by  the 
individual  soldier  himself.  To  see  that  the  instru- 
ments and  the  dressings,  the  operating-room  and 
the  hands  of  the  surgeon  are  surgically  clean  will 
cut  off  three  fourths  of  the  risks  of  infection;  but 
there  is  a  very  important  zone  of  danger,  amounting 
to  quite  twenty-five  or  thirty  per  cent,  which  has  to 
be  crossed  before  the  surgeon  ever  sees  the  wound; 
and  that  is  the  first-aid  dressings  and  their  use  by  the 
soldier  himself  or  his  comrades. 

You  cannot  always  choose  a  nice,  clean,  antisep- 
tic place  for  a  battle;  and  we  now  know  that  the 
bacteria  of  the  soil,  particularly  if  the  soil  be  culti- 
vated and  fertilized  with  various  decaying  vegetable 
and  animal  substances,  may  set  up  serious  trouble 
if  they  get  into  wounds.  Not  only  so,  but  there  are 


THE  REAL  PERILS  OF  WAR         37 

also  bacilli  that  make  themselves  more  or  less  at 
home  on  the  surface  of  the  human  skin  and  in  the 
pouches  of  the  hair  follicles  which,  if  they  get  into 
an  open  wound,  may  set  up  suppuration.  It  is,  there- 
fore, a  matter  of  first  importance  that  a  soldier  in  the 
field  should  keep  himself  and  his  clothing  —  par- 
ticularly his  underwear  —  in  as  clean,  thoroughly 
washed,  and  well-ventilated  condition  as  possible. 

It  is  particularly  desirable  before  going  into  battle 
to  put  on  a  suit  of  clean  underwear,  so  that  if  any 
strands  or  threads  of  clothing  are  carried  into  a  wound 
by  a  bullet  they  will  not  carry  germs  with  them.  One 
of  the  reasons  why  the  sea-fighters  of  Nelson's  day 
used  to  strip  themselves  naked  to  the  waist  when 
they  served  the  guns  was  that  they  had  discovered 
by  painful  experience  that  a  splinter  or  shot  which 
carried  with  it  into  the  wound  a  fragment  of  dirty 
and  sweat-soaked  clothing  added  hugely  to  the  risk 
of  painful  and  dangerous  suppuration. 

In  all  modern  armies  now  the  soldier  is  provided 
with  one  or,  in  some  cases,  two  packages  of  first- 
aid  dressings.  These  are  wrapped  up  in  oiled  paper 
or  oiled  cloth,  so  as  to  be  protected  from  moisture, 
dirt,  or  the  penetration  of  perspiration  if  carried  in 
pockets  or  knapsacks.  The  moment  a  wound  is  re- 
ceived the  sufferer,  or  one  of  his  comrades,  cuts  away 
the  clothing,  tears  open  the  package  of  dressing,  ap- 
plies the  pad  of  cotton  or  gauze  to  the  wound,  and 


38  THE  DOCTOR  IN  WAR 

binds  It  on  firmly  with  the  bandage.  Unless  an  ar- 
tery of  considerable  size  has  been  injured  the  pres- 
sure from  the  dressing  soon  arrests  the  hemorrhage, 
and  the  blood  clots  and  dries  all  over  the  surface  of 
the  wound  and  round  the  edges,  so  that  rifle  wounds 
are  perfectly  sealed  against  all  dirt  from  the  soil  or 
from  the  hands  of  the  sufferer  or  from  air  and  dust. 

The  success  of  this  immediate-dressing  method  is 
assisted  by  the  character  of  the  wounds  made  by 
the  high- velocity  bullets.  These  whirl  through  the  tis- 
sues at  such  a  tremendous  rate  of  speed  that  they 
pulverize  and  almost  cauterize  the  edges  of  the 
wound,  so  that  the  bleeding  from  it,  unless  a  large 
artery  be  actually  torn  across,  is  often  astonishingly 
slight. 

Another  advantage  of  the  modern  high-velocity 
bullets  is  that  the  wounds  they  make  are  almost 
absolutely  sterile.  The  reason  for  this  is  that  the 
tremendous  force  and  speed  with  which  they  are 
driven  through  the  grooves  of  the  rifle  barrel  raise 
them  to  such  a  heat  by  friction  that  any  accidental 
germs  that  might  have  become  attached  to  them  as 
a  result  of  their  being  dropped  on  the  ground,  or  car- 
ried in  dirty  pockets,  or  handled  with  infected  fingers, 
are  either  scraped  off  or  destroyed;  in  fact,  most 
fortunately,  the  modern  bullet,  like  the  flatiron  Bert 
Williams  left  home  just  six  inches  in  front  of,  has 
"  nuffin  whatever  attached  to  it  —  but  speed!  " 


A  WOUNDED  FRENCH  SOLDIER    RETURNING   ON   FOOT  TO   THE 
DRESSING-STATION 


THE  REAL  PERILS  OF  WAR         39 

On  the  whole,  though  this  was  by  no  means  the 
intention  of  their  inventors,  the  new  high-velocity 
bullets  are  more  humane  and  less  pain-producing 
than  the  old-fashioned  round  ball  or  soft  bullet.  The 
latter,  if  it  happened  to  strike  a  bone,  would  some- 
times spread  in  the  most  horrible  fashion  and  tear 
through  the  tissues  as  though  a  crowbar  had  been 
driven  through  them. 

The  infamous  dumdum  bullet,  in  fact,  is  a  hard 
metal  bullet  with  a  soft  perforated  lead  tip  or  nose, 
intended  to  mushroom  in  this  ghastly  fashion  when- 
ever it  strikes  a  bone.  The  new  high-speed  bullets, 
on  the  contrary,  drill  their  way  through  the  soft 
tissues  almost  as  cleanly  as  a  red-hot  bradawl. 
1^  Early  in  the  war,  in  Belgium,  one  of  the  German 
prisoners  presented  an  arm  to  be  dressed  which  he 
thought  had  been  slightly  grazed,  but  which  on 
examination  proved  to  have  been  drilled  completely 
through  by  a  bullet.  It  had  fortunately  missed  the 
bone  and  arteries,  and  so  produced  no  hemorrhage 
whatever,  leaving  only  a  little,  clean-cut,  black-and- 
blue-edged  hole  in  the  skin  on  the  front  and  on  the 
back  of  the  arm,  where  it  went  in  and  came  out  again. 

The  behavior  of  these  high-speed  bullets  when 
striking  bones,  however,  is  very  uncertain.  In  not  a 
few  cases  they  will  drill  right  through  an  arm  or  leg 
bone  without  even  cracking  it,  making  as  clean-cut 
a  hole  as  a  drill  or  a  trephine.   In  other  cases,  how- 


40  THE  DOCTOR  IN  WAR 

ever,  particularly  in  wounds  of  the  skull,  they  will 
shatter  the  bone  for  five  or  six  inches  in  every  di- 
rection, as  a  window  pane  is  shattered  by  a  stone, 
and  do  exceedingly  serious  damage.  They  may  also 
strike  some  obstacle,  or  ricochet  from  the  ground, 
bend  into  a  crescent  and  strike  sidewise,  with  ghastly 
smashings  and  tearings. 

On  the  whole,  however,  when  these  bullets  kill, 
they  kill  suddenly  and  painlessly.  The  wounds  are 
followed  by  little  hemorrhage  and  by  less  pain  than 
those  inflicted  by  the  old-fashioned  bullets;  the  risk 
of  suppuration  is  less;  and  they  heal  in  from  one  half 
to  two  thirds  of  the  time  required  by  other  wounds. 
Oddly  enough,  they  have  one  peculiar  disadvantage 
—  from  the  fighting-man's  point  of  view:  they  will 
not  stop  a  charge,  particularly  a  rush  of  savage  or 
barbarian  fanatics,  so  well  as  the  old-fashioned,  soft- 
lead  bullets ;  because  the  shock  when  they  strike  the 
body  is  not  nearly  so  severe.  But,  alas,  in  this  war 
eight  tenths  of  all  wounds  are  from  shell  fragments 
which  are  as  vicious  and  filthy  as  bullets  are  mild 
and  clean. 

The  lion's  share  of  the  saving  of  life  in  war  has 
been  in  the  prevention  of  sickness  on  the  field  and 
in  the  tented  camp.  We  are  not  yet  able  to  say  that 
war  itself  is  a  disease  and  preventable,  though  we  hope 
that  that  day  may  come;  but  we  can  say  that  four 
fifths  of  its  mortality,  as  waged  in  the  past,  was  due 


THE  REAL  PERILS  OF  WAR         41 

to  preventable  disease;  and  that  disease  is  not  only 
preventable,  but  is  being  actually  prevented  in  most 
modern  armies. 

The  sanitary  conditions  in  the  field  up  to  the  mid- 
dle of  the  nineteenth  century  were  something  appall- 
ing. In  the  Thirty  Years'  War,  from  161 8  to  1648, 
all  Central  Europe  was  turned  into  a  pesthouse; 
and,  though  less  than  sixty  battles  were  fought  in  the 
thirty  years,  army  after  army  melted  and  disap- 
peared, from  typhus,  from  dysentery,  and  the  Black 
Death,  from  famine,  from  food  poisoning,  smallpox, 
and  cholera. 

The  great  Gustavus  Adolphus,  after  one  deadly 
winter  in  quarters,  found  himself  practically  with- 
out an  army,  and  lost  during  the  winter's  rest  more 
than  ten  times  as  many  men  as  during  the  summer's 
campaign.  There  was  no  drainage,  no  vaccination, 
no  method  of  preventing  the  spread  of  infection. 
There  were  no  surgeons  or  medical  corps,  though  a 
few  of  the  generals  and  noblemen  took  their  private 
surgeons  into  the  field. 

Even  this  painfully  inadequate  attempt  to  care 
for  the  wounded  dates  back  only  to  the  fifteenth 
century,  in  the  campaign  of  Agincourt  and  the  army 
of  Henry  V,  five  hundred  years  ago.  The  great  pio- 
neer of  military  surgery,  Ambroise  Pare,  discovered 
on  the  field  of  battle  the  superiority  of  the  silk- thread 
ligature  to  the  cautery  or  hot  iron  for  checking  hem- 


42  THE  .DOCTOR  IN  WAR 

orrhage;  but  he  served  only  in  the  capacity  of  pri- 
vate physician  to  the  Duke  of  Guise.  In  the  light 
of  recent  events  it  sounds  Hke  the  echo  from  some 
nightmare  to  note  that  the  campaign  in  which  he 
made  this  famous  discovery  was  the  siege  of  Metz 
in  the  sixteenth  century. 

Even  two  hundred  years  later  Frederick  the  Great 
declared  that  fever  alone  cost  him  more  than  seven 
great  battles.  This  was  hardly  to  be  wondered  at  when 
we  remember  that,  although  there  were  regimental 
surgeons,  they  were  very  poorly  equipped,  and,  what 
was  still  worse,  were  almost  entirely  unprovided 
with  hospitals  or  nurses.  Incredible  as  it  sounds, 
hospitals  were  not  considered  a  necessary  part  of 
army  equipment  until  the  time  of  Louis  XIV.  Vol- 
taire describes  these  new  and  wonderful  provisions 
of  humanity  as  they  were  conducted  in  1707  — 
again  with  a  distressing  reminder  of  a  modem  in- 
stance —  at  the  siege  of  Lille. 

Napoleon  cared  very  little  for  his  sick  and  wounded. 
He  simply  threw  them  into  barns,  outhouses,  village 
hovels,  or  peasants'  huts,  left  them^there  and  swept 
on;  but  it  was  during  his  disastrous  wars  that  the 
first  clear  instance  of  a  really  effective,  working  army 
medical  service  appeared,  and  that  was  in  the  Eng- 
lish army  under  Wellington  in  the  Spanish  Penin- 
sula. It  was  crude  and  imperfect,  according  to  mod- 
em standards,  but  it  kept  down  the  disease  death- 


THE  REAL  PERILS  OF  WAR         43 

rate  to  a  little  more  than  half  that  of  the  French 
army.  The  fact  made  such  an  impression  that  even  a 
military  historian  was  struck  by  it,  declaring  that 
the  work  of  the  army  surgeons  had  probably  prac- 
tically decided  the  result  of  the  crucial  battle  by 
adding  a  full  division  to  the  strength  of  Wellington's 
army.  A  century  later  the  Japanese  deliberately 
calculated  that  they  could  neutralize  Russia's  supe- 
rior numbers  by  keeping  fifty  per  cent  fewer  men  in 
the  hospital. 

The  sanitarian  is  a  powerful  factor  in  modern  war, 
though  he  gets  few  medals  or  promotions  for  it.  The 
lesson  appeared  to  have  been  soon  forgotten,  how- 
ever, for  in  the  next  serious  war  —  the  Crimean,  in 
1854  —  the  English  troops  went  into  the  campaign 
so  badly  equipped  that  their  disease  death-rate  rose 
to  the  enormous  figure  of  twenty-three  per  cent  a 
year  —  more  than  four  times  as  great  as  the  battle 
death-rate.  Thirty  per  cent  of  their  eighty  thousand 
men  perished  in  the  first  campaign.  Fortunately 
this  horrible  loss  recalled  them  to  their  senses.  A 
sanitary  system  was  organized  and  equipped,  at  the 
head  of  which  Florence  Nightingale  won  her  immor- 
tal fame.  Camps  were  properly  policed;  food-sup- 
plies were  improved ;  good  hospitals  were  established ; 
and  the  disease  death-rate  of  the  second  summer 
campaign  was  reduced  to  less  than  a  tenth  of  the 
first. 


44  THE  DOCTOR  IN  WAR 

It  was  most  significant  that  the  first  great  victory 
in  our  permanent  triumph  over  disease  in  war  was 
won  by  woman ;  and  she  has  been  repeating  the  per- 
formance ever  since;  the  nursing  service,  the  Red 
Cross,  the  ambulance,  and  the  field  hospital  would 
be  impossible  without  her.  Her  courage  and  her  de- 
votion are  equal  to  that  of  the  fighting-man,  for  she 
actually  faces  the  deadliest  risks  of  war  —  disease, 
poor  food,  bad  water,  and  privations. 

And  when  the  hospital  comes  under  fire  she  goes 
about  her  duties  unflinchingly,  as  steady  as  a  vet- 
eran of  the  Old  Guard.  She  hates  war,  not  because 
she  is  afraid  of  blood,  —  there  has  been  more  blood 
shed  bravely  in  the  birth-chamber  than  on  the  field 
of  battle,  —  but  because  she  sees  it  for  what  it  is. 
She  is  becoming  more  and  more  an  influence  to  be 
reckoned  with. 

Woman  has  done  wonders  toward  humanizing  war 
—  some  day  she  will  abolish  it  altogether.  Our  own 
American  Civil  War  profited  by  this  terrible  experi- 
ence; and,  though  coming  only  seven  years  later, 
succeeded  in  cutting  the  Crimean  death-rate  almost 
in  two. 

Finally,  in  the  Franco-Prussian,  the  Spanish- 
American,  and  Boer  Wars,  the  lowest  death-rate 
from  disease  yet  recorded  was  attained  —  that  is, 
two  and  a  half  per  cent.  Even  the  brilliant  and  mag- 
nificent work  of  the  Japanese  medical  corps  in  the 


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THE  REAL  PERILS  OF  WAR        45 

war  with  Russia  did  not  succeed  in  lowering  this 
average  more  than  a  fraction  of  one  per  cent.  Its  real 
triumph  lay  in  the  fact  that,  instead  of  the  war  be- 
ing waged,  like  most  of  our  own  Spanish-American 
War  or  the  Franco-Prussian  War,  in  civilized  and 
temperate  countries  —  four  fifths  of  our  war  loss 
was  on  our  own  soil — ^it  was  waged  in  a  densely 
populated,  half-civilized  country,  reeking  with  filth, 
with  scarcely  a  stream  free  from  typhoid  contami- 
nation, and  sown  from  one  end  to  the  other  with 
typhoid,  typhus,  smallpox,  cholera,  and  the  great 
Black  Death  itself  in  its  most  virulent  form.  To  win 
under  those  circumstances  a  disease  death-rate  for 
an  army  of  three  quarters  of  a  million  men,  for  nearly 
two  years,  of  barely  two  and  a  half  per  cent,  equal- 
ing that  of  the  Germans  in  their  brief  four  months* 
campaign  in  one  of  the  healthiest  countries  in  Europe, 
was  a  triumph  of  which  the  Japanese  medical  corps 
is  entitled  to  be  proud. 

The  Japanese  were  the  first  openly  to  adopt  the 
rule  that  the  doctor's  place  is  in  the  first  line  of  the 
advance  guard,  with  the  scouts  and  cavalry  patrols. 
Every  well  was  tested  and  labeled  hours  or  days 
before  the  main  army  reached  it;  and  if  infected  it 
was  guarded  by  a  sentinel  with  fixed  bayonet.  Every 
village  was  rigorously  inspected,  cesspools  disin- 
fected, and  all  cases  of  infectious  disease  quaran- 
tined.   Food  brought  in  by  foragers  was  examined 


46  THE  DOCTOR  IN  WAR 

with  the  microscope  and  tested  with  reagents  before 
it  was  used.  Mosquito  pools  were  kerosened,  camp- 
grounds selected  in  advance  and,  if  necessary, 
drained.  Nothing  was  left  to  chance. 

We  had,  indeed,  good  reason  to  reproach  ourselves 
for  our  unnecessary  waste  of  life  in  the  Cuban  cam- 
paign of  our  Spanish  War,  but  this  was  solely  on  the 
ground  that  of  the  fifty-four  hundred  deaths  from 
disease,  nearly  four  fifths  died  on  our  own  soil  from 
one  preventable  disease  —  typhoid  fever. 

Our  work  in  the  Philippines  was  admirable,  and 
our  total  death-rate  from  sickness  during  the  whole 
war  was  small,  —  one  of  the  lowest  in  history,  — ■ 
though,  by  contrast  with  the  fact  that  it  was  more 
than  five  times  as  great  as  our  losses  in  battle,  it 
caused  us  much  reproach  and  heartburning. 

Our  death-rate  in  battle,  however,  owing  to  the 
fewness  of  actual  engagements  and  the  guerrilla  war- 
fare that  made  up  most  of  the  campaign,  was  the 
lowest  in  recorded  history  —  less  than  a  half  of  one 
per  cent. 

Though  we  in  America  have  had  no  wars  since 
then  till  now,  we  have  been  able  to  assure  ourselves 
of  the  high  standard  of  efficiency  reached  by  our 
medical  and  sanitary  army  corps  against  the  dread 
enemy  of  the  soldier,  disease,  by  maintaining  two 
armies  in  the  field,  each  for  a  considerable  period 
of  time. 


THE  REAL  PERILS  OF  WAR        47 

One  of  these  was  the  army  of  observation  encamped 
along  the  Mexican  frontier  during  the  whole  sum- 
mer of  191 2.  It  was  placed  in  much  the  same  cli- 
mate and  circumstances  —  if  anything  slightly  more 
unfavorable  on  account  of  the  heat,  poor  water-sup- 
ply, and  infection  from  Mexican  villages  —  as  our 
army  in  Florida  during  the  Cuban  campaign.  For- 
tunately for  purposes  of  comparison  the  numbers 
happened  to  be  almost  identical  —  something  over 
twenty-five  thousand  men  in  Florida  in  1898  and 
about  thirty  thousand  in  Texas  in  191 2.  The  death- 
rate  from  disease  in  Florida  for  the  season  was  two 
and  a  half  per  cent;  that  in  Texas  was  about  two 
thirds  of  one  per  cent. 

A  large  share  of  this  splendid  reduction  was  due 
to  the  difference  in  one  factor,  typhoid  fever,  which 
caused  something  like  eight  tenths  of  the  deaths 
that  occurred  in  Florida,  whereas  of  the  thirty  thou- 
sand troops  in  Texas  only  three  men  died  of  typhoid ! 
The  reason  for  this  was  medicine's  latest  and  well- 
nigh  greatest  contribution  to' the  saving  of  life  in  war- 
time —  the  discovery  of  a  vaccine  or  protective  in- 
oculation against  typhoid  fever.  Three  injections 
of  this  at  intervals  of  about  ten  days  will  diminish  a 
man's  chances  of  contracting  typhoid,  under  the 
most  unfavorable  circumstances,  to  about  one  in  a 
thousand  for  a  period  of  from  two  to  five  years,  and 
possibly  longer. 


48  THE  DOCTOR  IN  WAR 

The  other  sanitary  triumph  of  our  American  army 
medical  corps  was  the  occupation  of  Vera  Cruz. 
Thirty-five  thousand  men  landed  and  took  posses- 
sion of  a  hostile  city  in  the  famous  tierra  caliente  of 
Mexico,  reputed  to  be  one  of  the  deadliest  climates 
in  the  world  and  at  the  most  unhealthy  season  of  the 
year.  The  town  reeked  with  malaria  and  was  full  of 
smallpox  and  dysentery.  An  active  mosquito  war 
was  begun  at  once  and  the  weapons  used  were  kero- 
sene, quinine,  and  ditches.  Four  fifths  of  the  na- 
tive population  of  sixty  thousand  were  vaccinated 
within  two  months,  with  the  result  that  both  malaria 
and  smallpox  practically  disappeared. 

The  city  was  cleaned,  drained,  and  its  water- 
supply  purified,  with  the  amazing  result  that,  of 
thirty-five  thousand  soldiers,  only  one  died  of  disease 
in  three  months;  and  the  death-rate  of  the  native 
population  was  cut  in  two.  War  no  longer  brings 
in  its  train  famine  and  pestilence.  Almost  the  only 
soldiers  sick  were  those  on  outpost  duty,  exposed 
to  flies  and  mosquitoes  from  Mexican  territory. 

These  are  fair  illustrations  of  one  of  the  most  en- 
couraging aspects  of  our  great  reduction  of  the  death- 
rate  in  war  —  that  its  victories  are  won  against  the 
same  enemies  which  cause  our  heaviest  death-rate 
in  time  of  peace. 

From  the  point  of  view  of  disease,  war  brings  no 
evils  in  its  train,  but  merely  aggravates  and  exag- 


THE  REAL  PERILS  OF  WAR         49 

gerates  by  its  overcrowding,  poor  drainage,  under- 
feeding and  exposure  to  wet  and  cold  in  temperate 
zones,  and  to  the  winged  pestilence  that  carries 
malaria  and  yellow  fever  in  tropical  climates  —  the 
same  diseases  that  mow  us  down  in  the  times  of 
peace.  So  the  lessons  learned  on  the  tented  field  can 
be  carried  back  and  applied  in  the  village  and  the 
town  in  the  peaceful  country. 

In  fact,  we  have  recently  been  given  one  brilliant 
and  superb  demonstration  of  what  can  be  done  in 
peaceful  enterprises,  by  carrying  out  the  methods  of 
military  sanitation,  in  the  triumphant  building  of 
our  Panama  Canal.  We  have  already  reduced  the 
death-rate  in  the  bloodiest  war  to  less  than  half  of 
that  of  absolute  peace  two  hundred  years  ago. 
*  Now,  by  the  application  of  military  methods  to 
peaceful  enterprises  we  have  succeeded  in  lowering 
the  death-rate  of  a  body  of  over  thirty  thousand  men 
and  women  —  yes,  and  children  —  not  merely  in  the 
tropics,  but  inthe  deadliest  and  most  sweltering  pest- 
hole in  the  civilized  world  and  in  all  history,  the 
Isthmus  of  Panama,  to  a  little  more  than  half  of  one 
per  cent  a  year,  which  is  less  than  half  the  death-rate 
of  the  entire  population  of  the  United  States. 

Of  course,  it  was  a  picked  group  of  strong,  vigorous 
workers  —  both  men  and  women  —  who  had  passed 
rigid  physical  examinations ;  but  it  is  safe  to  say  that 
it  was  a  fair  sample  of  what  might  be  done  for  the 


50  THE  DOCTOR  IN  WAR 

entire  population  of  any  State  in  the  Union  if  Gen- 
eral Gorgas  were  given  there  the  same  free  hand  he 
had  in  Panama  to  feed,  house,  and  protect  from  in- 
fection. 

War  is  horrible  and  will  always  remain  so;  but  we 
have  robbed  it  of  some  of  its  terrors  within  the  last 
century.  The  next  step  should  be  to  wipe  it  out  alto- 
gether. 

Modern  war  is  forty  per  cent  engineering,  fifty  per 
cent  sanitation,  and  the  rest  strategy.  An  army,  as 
Napoleon  said,  is  like  a  serpent  —  it  travels  on  its 
belly.  Put  your  men  on  the  fighting  line  in  good 
health  and  in  fair  numbers,  and,  as  Sherman  said, 
"You  need  have  no  fear  but  they'll  fight." 

The  whole  science  of  war,  as  Forrest,  the  famous 
Confederate  cavalry  chief,  pithily  remarked,  is  "get- 
ting the  mostest  men  there  the  fustest."  The  two 
things  that  most  powerfully  promote  this  result  are 
transportation  and  sanitation.  Other  things  being 
equal,  the  army  that  has  fewest  men  in  the  hospital 
will  win  most  battles. 

An  army  with  good  doctors  has  a  thirty  per  cent 
advantage  over  one  with  poor  ones.  Can  the  same 
be  said  of  generals? 


Ill 

FEEDING  A  MILLION  MEN 
What  the  Soldier  eats 

HOW  a  soldier  will  fight  depends,  first,  on  how 
he  is  armed,  and,  second,  on  how  well  he  is  fed. 
We  hear  a  great  deal  about  warlike  and  unwarlike 
races,  about  mild  and  peace-loving  nations,  and 
famous  fighting  strains;  but  almost  any  race,  how- 
ever tall  or  short,  dark  or  fair,  savage,  half-savage, 
or  civilized,  if  well  fed,  fairly  armed,  and  halfway 
decently  led  and  trained,  will  furnish  a  pretty  fair 
article  of  fighting  men,  quite  good  enough  for  all 
practical  purposes  of  warfare,  whether  mediaeval  or 
modem.  Courage,  like  most  other  good  things,  is 
one  of  the  most  frequent  of  human  virtues,  and  will 
come  to  the  surface  as  soon  as  it  is  given  a  decent 
physical  basis  on  which  to  stand.  From  the  days  of 
the  Foreign  Legions  of  Rome  and  the  Janizaries  of 
Constantinople  to  England's  Ghurkas  and  Sikhs  and 
France's  Turcos  and  Senegalese,  the  dominant  race 
has  turned  painted  and  nose-ringed^savages  into  first- 
class  fighting  machines. 

Even  out  of  the  most  peaceful  and  sheeplike  of 
races,  like  the  Chinese  coolies,  Gordon  was  able,  in 
three  years,  to  form  his  famous  Ever  Victorious 


52  THE  DOCTOR  IN  WAR 

Army,  which  never  fought  against  odds  of  less  than 
three  and  usually  ten  to  one,  but  was  never  defeated, 
and  which  he  expressed  his  perfect  willingness  to 
match  against  an  equal  number  of  any  known  Euro- 
pean line  regiments. 

Explanations  of  the  transformation  have  been 
varied  and  superficial  —  military  drill,  according  to 
one  opinion;  superior  weapons,  to  another;  confidence 
in  white  officers,  to  a  third.  But  the  deliberate  judg- 
ment of  competent  experts  is  that  half  the  miracle 
was  wrought  by  better  food.  That  was  Gordon's  own 
explanation  of  the  major  part  of  his  triumphant  feat. 

An  army  in  the  field  seems  to  rest  solidly  on  the 
ground ;  up  to  its  knees  in  it,  in  fact,  if  the  rains  have 
been  heavy.  Practically,  however,  it  is  up  in  the  air, 
supported  by  a  tripod,  one  leg  of  which  is  ammuni- 
tion; another,  rations;  and  the  third,  sanitation. 
Knock  any  one  of  those  legs  from  under  it,  and  it 
goes  down,  flop,  like  a  bird  with  a  broken  wing. 

We  hear  much  of  the  tremendous  problem  of  mo- 
bilizing an  army,  of  assembling  and  entraining  troops, 
and  massing  them  on  the  frontier  in  three,  five,  or 
seven  days  from  the  declaration  of  war.  It  is  a  tre- 
mendous and  difficult  feat;  but  it  is  merely  a  sum- 
mer holiday  compared  with  the  exhausting  and 
never-ending  problem  of  feeding  them  after  getting 
them  there,  which  becomes  still  more  difficult  as  they 
march  into  the  enemy's  country.  /' 


FEEDING  A  MILLION  MEN         53 

It  requires  a  tremendous  number  of  troop  trains 
to  deliver  an  army  of  two  hundred  thousand  men  on 
the  fighting  Hne;  but  when  that  has  once  been  done 
it  is  over  and  seldom  needs  to  be  repeated  on  the 
same  scale,  fractional  units  only,  as  a  rule,  being 
moved  at  intervals  of  several  weeks  or  months. 

Each  of  those  two  hundred  thousand  men,  how- 
ever, eats  his  own  weight  in  food  every  thirty  days; 
and  that  means  a  never-ending  succession  of  freight 
and  supply  trains,  pouring  constantly  backward  and 
forward  all  day  and  all  night,  as  long  as  the  war  lasts. 
And  there  can  be  absolutely  no  let-up  in  this  toil- 
some service,  no  excuses  for  breakdowns,  no  breath- 
ing-spells or  vacations.  That  rumbling,  lumbering, 
never-sleeping  line  of  communication  is  the  very 
aorta  of  an  army  —  the  great  artery  through  which 
pours  its  life-blood. 

In  the  early  days  the  problem  of  rations  was  a 
comparatively  simple  one,  for  each  soldier  supplied 
himself,  carrying  enough  at  his  saddlebow  or  in  his 
haversack  to  last  him  until  he  got  into  the  enemy's 
country,  when  the  rest  was  easy.  War,  in  the  be- 
ginning, was  systematized  robbery  and  plunder;  and 
it  has  not  changed  much  even  in  this  twentieth  cen- 
tury. The  principal  inducement  to  go  to  war  was 
the  excellent  excuse  it  gave  for  plundering  and  loot- 
ing, and  living  off  the  country  generally. 

So  vitally  important  is  food  to  an  army  that  any- 


54  THE  DOCTOR  IN  WAR 

thing  which  hinders  a  soldier  from  utilizing  to  the 
full  his  ration  disqualifies  him  at  once.  In  modern 
recruiting  offices  more  applicants  are  rejected  to-day 
for  defective  teeth  than  for  any  three  other  defects. 
This  seems  little  short  of  absurd  to  the  non-expert, 
and  one  can  hardly  help  sympathizing  with  the  re- 
cruit who  a  few  weeks  ago  volunteered  for  service  in 
England.  He  was  a  bony,  sturdy  Scot  and  could 
hardly  believe  his  ears  when  told  he  was  rejected. 
The  examiner  regretfully  explained  that  the  only 
cause  was  his  decayed  teeth.  Fixing  a  dark  and  re- 
proachful gaze  on  the  officer,  he  exclaimed:  — 

"Mon,  yeV  makkin*  a  gran'  mistak'.  Ah'm  no 
wantin'  to  bite  the  enemy,  ah  want  to  shoot  *im!'* 

Moreover,  wars  were  formerly  casual,  fitful  affairs, 
and  lasted  only  so  long  as  the  food-supply  of  the 
invader  and  invaded  held  out,  then  collapsed  of  their 
own  accord.  In  those  days  the  best  soldier  was  the 
man  who  could  go  longest  without  food  or  live  on 
the  coarsest  and  cheapest  foodstuff.  The  inhabi- 
tants of  the  rich  plains  and  fertile  valleys  were  per- 
petually being  harried  by  swarm  after  swarm  of  hill- 
men  and  mountaineers,  caterans,  moss-troopers, 
night-riders,  and  banditti,  who  came  down,  hungry 
and  steel-clad,  out  of  their  wretched  fastnesses  once 
or  twice  a  year  for  a  square  meal. 

The  earliest  commissariat  started,  for  obvious 
reasons,  with  a  decidedly  restricted,  solid  —  not  to 


FEEDING  A  MILLION  MEN         55 

say  stodgy  and  unattractive  —  group  of  food  fuels. 
Foods,  to  be  suitable  for  army  supplies,  must,  of 
course,  be  of  proved  and  high  nutritive  value.  They 
must  be  as  compact  as  possible  —  that  is  to  say,  have 
as  much  nourishment  for  their  bulk  and  weight  as 
feasible,  so  as  not  to  cost  too  much  for  transportation. 
And  they  must  be  in  such  form  as  to  keep  well  and 
stand  considerable  variations  of  climate  and  vicissi- 
tudes in  handling  and  storing  without  spoiling. 

Naturally  a  few  pieces  de  resistance,  as  the  French 
call  them,  poked  their  heads  into  the  limelight  at 
once  —  salt  meats,  particularly  beef  and  pork;  hard 
biscuit;  flour,  beans,  and  fat.  The  judgment  that 
selected  these  staples  was  sound;  and  to  this  day  the 
bulk  of  army  supplies,  particularly  for  a  rapidly 
moving  force  —  its  backbone  or  principal  staples  — 
consists  of  salt  beef,  salt  pork,  bacon  or  ham,  hard- 
tack, flour,  rice  or  corn  meal,  beans,  and  butter. 

It  was  soon  found,  however,  that  though  a  ration 
of  salt  beef  or  pork,  with  wheat,  rye,  or  barley  bread, 
and  fat,  furnished  the  essentials  of  a  diet  and  sup- 
plied the  necessary  fuel  units  or  calories  in  as  com- 
pact, durable,  and  transportable  form  as  could  any- 
where be  discovered,  it  had  certain  very  serious 
draw-backs. 

Of  course,  it  is  only  fair  to  remember  that  these 
articles  of  food  were  never  intended  to  form,  so  to 
speak,  more  than  the  backbone  of  the  ration;  and 


S6  THE  DOCTOR  IN  WAR 

that  lighter,  less  nutritious  and  more  perishable 
things,  like  fruits  and  vegetables  and  sweets,  were 
expected  to  be  secured  from  the  enemy's  country. 
But  with  the  wanton  and  reckless  methods  of  waging 
war,  setting  fire  to  standing  crops,  hacking  down 
orchards,  burning  stacks  and  granaries  and  barns, 
and  pillaging  and  murdering  non-combatants — ■ 
which  until  recently  we  thought  we  had  outlived  — ■ 
a  country  much  fought  over  soon  became  such  a 
desert  that  armies  were  compelled  to  live  on  the 
rations  given  them.  And  the  moment  they  were  so 
restricted  for  more  than  a  few  weeks  they  began  to 
go  down  like  sheep  —  partly  with  ordinary  diseases, 
like  typhoid,  dysentery,  pneumonia,  and  so  on,  which 
flourish  on  a  lowered  resistance,  and  partly  from  a 
perfectly  definite  and  unique  disease  called  scurvy, 
or  scorbutus,  due  entirely  to  the  absence  of  certain 
elements  from  the  food. 

So  serious  and  so  rapid  were  the  ravages  of  this 
disease  that  in  the  Middle  Ages  it  was  no  unusual 
thing  for  an  army  to  have  one  third,  one  half,  or  even 
two  thirds  of  its  rank  and  file  prostrated  by  it,  and 
from  a  tenth  to  a  fifth  killed. 

For  centuries  scurvy  was  supposed  to  be  merely 
one  of  the  innumerable  plagues  and  pestilences  that 
sprang  up  in  the  track  of  war;  and  it  was  not  until 
about  two  hundred  years  ago,  just  before  the  time 
of  Captain  Cook's  voyages  round  the  world,  that  we 


FEEDING  A  MILLION  MEN         57 

discovered  that  this  loathsome  and  deadly  disease, 
which  loosened  the  teeth  in  the  jaws,  caused  the 
joints  to  swell  and  become  inflamed,  and  simply 
melted  the  walls  of  the  blood  vessels,  letting  hemor- 
rhages leak  out  all  over  both  the  inner  and  outer 
surfaces  of  the  body,  was  due  solely  to  the  absence  of 
fruit  acids  and  vegetable  alkalies  from  the  diet,  and 
could  be  absolutely  cured  or  prevented  by  such  a 
simple  charm  as  an  ounce  of  lemon  juice  or  half  a 
raw  potato  a  day  for  each  man. 

By  this  time  scurvy  had  become  practically  con- 
fined to  ships'  crews,  both  in  the  navy  and  in  the 
merchant  marine.  So  lemon  juice  or  lime  juice  was 
ordered  by  law  to  be  added  to  all  ships'  stores;  and 
for  several  generations  afterward  the  old  merchant- 
men that  sailed  round  the  Horn  were  known  as  ' '  lime- 
juicers,"  from  the  fact  that  they  were  required  to 
carry  a  regular  stock  of  that  life-saving  article. 

For  fifty  years —  indeed,  practically  for  a  century 
past  —  the  civilized  army  ration  has  contained  not 
merely  bread,  meat,  and  fat,  but  either  fruits  or  vege- 
tables, and  usually  both.  This  modification  was, 
however,  brought  about  in  a  rather  curious  and  in- 
direct way.  For  many  years,  and  even  now  in  some 
armies,  no  vegetables,  fruit,  or  sugar  appeared  in  the 
formal  list  of  supplies  issued  to  the  troops. 

At  first  sight  it  would  appear  as  though  these 
were  not  considered  to  be  needed  in  the  ration.  And 


58  THE  DOCTOR  IN  WAR 

anything  more  uninteresting  than  the  list  of  so 
many  ounces  of  bread,  so  many  grams  of  beef,  with 
or  without  bone,  so  many  ounces  of  lard,  grams  of 
sugar,  and  grains  of  salt,  can  hardly  be  imagined. 
It  sounds  as  bleak  and  unattractive  as  a  prescrip- 
tion. 

When,  however,  you  read  between  the  lines  and 
peruse  the  supplementary  regulations,  you  will  dis- 
cover that  though,  with  the  rigidity  characteristic 
of  the  military  mind,  no  departure  has  been  per- 
mitted from  the  sacred  and  time-honored  list  of  solid 
slabs  of  food  handed  down  from  Mount  Sinai,  these 
are  issued  to  the  soldier  in  such  amounts  that  he 
cannot  possibly  eat  the  whole  of  his  ration,  and  is 
graciously  permitted  to  sell  or  exchange  the  surplus 
for  fruits,  vegetables,  sweets,  and  such  simple  luxuries 
as  he  may  crave. 

It  is  a  clumsy  old  survival  of  barbarism,  redolent 
of  the  times  when  barter  was  the  only  basis  of  ex- 
change, money  was  scarce,  and  bills  of  sale  were  un- 
known ;  but  it  is  supposed  to  put  the  soldier  or  mess 
sergeant  on  his  own  responsibility,  and  it  saves  brain- 
fag in  the  adjutant  general's  department. 

It  has,  however,  become  largely  a  matter  of  form 
or  a  make-believe  game  of  bookkeeping,  for  the  full 
excessive  ration  is  seldom  actually  issued.  Each 
company  or  mess  is  credited  with  so  much  money 
expressed  in  terms  of  beef,  pork,  and  flour,  and  it 


FEEDING  A  MILLION  MEN         59 

is  permitted  to  spend  the  value  of  whatever  surplus 
remains  for  fruit,  fresh  vegetables,  canned  goods, 
sweets,  pastry,  soft  drinks,  and  so  on,  either  at  the 
army  stores  or  in  the  local  shops. 

Indeed,  the  majority  of  modern  armies  stock  and 
supply  their  commissariat  departments  with  a  splen- 
did variety  of  the  very  best  quality  of  all  sorts  of 
not  merely  groceries,  fruits,  and  vegetables,  but  even 
delicatessen  relishes  and  minor  luxuries,  which  the 
various  messes  are  allowed  to  select  to  the  amount  of 
their  surplus  bread,  beef,  and  pork,  at  the  ruling 
prices  of, those  staples. 

Another  thing  discovered  by  our  experience  with 
scurvy  is  that  our  quick-growing,  instinctive  dis- 
taste for  salted  or  preserved  meats,  if  served  for  more 
than  one  or  two  meals  a  week,  or  for  a  few  days  or 
weeks  at  a  stretch,  has  a  sound  physiologic  basis. 
Though  the  surest  provocative  of  scurvy  is  absence 
of  fresh  fruit  or  fresh  vegetables  from  the  diet, 
there  are  other  forms  of  anaemia  and  blood  impov- 
erishment, as  well  as  serious  nutritional  disturbances, 
that  are  much  less  likely  to  occur  if  the  meat  in  the 
ration  is  provided  fresh  instead  of  salt. 

Practically  every  modern  army  now  issues  its 
meat  ration  in  the  form  of  fresh  beef  or  mutton  and, 
where  it  can,  supplements  it  with  fish  —  though,  of 
course,  relying  to  a  great  degree  on  bacon  or  salt  beef 
in  the  exigencies  of  a  campaign. 


6o  THE  DOCTOR  IN  WAR 

This  has  made  a  great  improvement;  but  there  was 
still  something  lacking.  And  though  it  was  always 
considered  good  strategy  to  encourage  soldiers  to 
forage  as  much  as  possible  from  the  countries  through 
which  they  passed,  it  was  found  that,  on  a  diet  of 
simple  bread,  meat,  and  fat,  cravings  for  variety  and 
other  foods  developed  to  such  a  degree  as  either  to 
impair  the  health  of  the  troops  or  make  them  so 
ravenously  hungry  for  all  sorts  of  desserts  and  trim- 
mings that  they  devoured  eagerly  every  kind  of  in- 
digestible and  unsuitable  green  stuff  and  sweet  stuff 
they  could  get. 

This  craving  was  found  to  be  particularly  keen  for 
sweets  of  all  sorts;  and  as  soon  as  the  new-found 
luxury,  sugar,  became  cheap  enough  to  be  available 
for  army  supplies,  it  was  tested  out  with  fear  and 
trembling,  and  found  to  be  not  merely  free  from 
danger,  but  an  extremely  wholesome,  digestible,  and 
readily  assimilable  food;  and  it  was  added  to  the 
army  ration. 

Practically  all  modern  army  rations  now,  partic- 
ularly the  emergency  ration  intended  for  the  sup- 
port of  bodies  of  troops  in  the  field,  away  from  their 
supply  trains,  contain  sugar,  not  merely  by  the  ounce, 
but  by  the  pound.  The  modem  emergency  ration, 
for  instance,  consists  of  sugar  in  the  form  of  choco- 
late, bacon,  pork,  fat,  dried  albumen,  made  either 
from  white  of  egg  or  curds  of  milk,  and  a  sort  of  pea- 


FEEDING  A  MILLION  MEN         6i 

meal  sausage,  containing  dried  peas,  beans,  or  len- 
tils, combined  with  flavoring  herbs  —  the  latter  made 
in  Germany  and  of  a  surpassing  nastiness. 

These  ingredients  are  mixed  together  into  a  solid 
cake,  which  may  be  eaten  raw  or  cooked,  or  else  com- 
bined with  water  and  made  into  a  sort  of  sweet  soup ; 
and  sometimes  they  are  used  in  separate  slabs.  The 
soldier  greatly  prefers  the  latter  arrangement,  as  it 
enables  him  eagerly  to  devour  the  chocolate,  fry  and 
eat  the  bacon,  and  throw  away  the  pea-meal  sausage. 

Another  substance  found  very  satisfactory  as  an 
emergency  ration  is  the  famous  and  hallowed  pem- 
mican  of  our  boyhood  days,  when  we  adore  James 
Fenimore  Cooper.  This  consists  of  meat  of  some 
sort,  either  beef,  pork,  or  mutton  —  it  was  origi- 
nally, of  course,  made  of  venison  or  buffalo  meat  — 
mixed  with  sugar,  raisins,  currants,  dates,  prunes, 
or  other  dried  fruits,  packed  into  canvas  or  leather 
bags,  which  are  filled  and  sealed  over  with  melted 
fat.  It  may  be  eaten  in  chunks,  with  bread  or  bis- 
cuit, or  made  into  an  appetizing  and  nutritious 
stew. 

,  The  army  ration  has  given  the  finishing  blow  to 
our  ancient  nursery  superstition  about  the  unwhole- 
someness  of  sugar  and  the  way  it  makes  our  teeth 
decay,  and  our  livers  become  enlarged,  and  our 
joints  inflamed  with  gout  and  rheumatism,  and  our 
kidneys   ''Brightsy."    It  is  one  of  the  best,  most 


62  THE  DOCTOR  IN  WAR 

readily  digestible  and,  at  present  prices,  cheapest 
forms  of  body  fuel  we  have.  Three  quarters  of  the 
work  of  the  body  is  probably  done  by  burning  sugar 
in  the  cells  of  our  muscles,  which  later  turn  it  into 
alcohol  and  explode  it  in  much  the  same  way  that 
gasoline  vapor  is  exploded  in  the  cylinders  of  an 
automobile  — -  only  the  cylinders  are  so  innumerable 
and  so  tiny  that  we  do  not  hear  any  chugging  and  do 
not  get  the  familiar  smell. 

This  brings  the  army  ration  or  fuel  supply  of  the 
fighting  machine  down  to  practically  an  irreducible 
minimum  of  five  main  type-fuels,  lacking  any  one 
of  which  disease  and  breakdown  are  certain — • 
bread,  beef,  fat,  sugar,  and  either  fruit  juice  or  vege- 
tables. 

Even  such  a  trifling  ingredient  as  salt  is  abso- 
lutely indispensable,  and  its  absence  is  instantly 
felt.  On  one  of  its  wonderful  fast  forced  marches, 
which  established  the  world's  record  for  infantry, 
a  division  of  Stonewall  Jackson's  famous  *'foot 
cavalry'*  left  its  wagons  so  far  behind  that  it  was 
forced  to  live  for  three  days  on  nothing  but  green 
com,  picked  and  roasted  in  the  field.  When  the  men 
struck  the  supply  train  their  first  wild  rush  was  for 
the  salt  barrels,  which  they  stove  in  at  once;  and, 
scooping  up  the  salt  in  handfuls,  they,  licked  it  up  as 
eagerly  as  colts  eat  clover  in  a  clover  field. 

The  next  problem  was:   Can   any  of   these  be 


FEEDING  A  MILLION  MEN         63 

exchanged  for  something  either  cheaper  or  better 
adapted  for  transportation  and  keeping?  Experi- 
ments in  this  direction  have  been  innumerable;  but 
the  net  result  has  been  to  leave  the  foundation  stones 
of  army  diet  pretty  much  where  they  were  in  the 
beginning.  ^ 

Beginning  with  bread,  every  imaginable  grain, 
nut,  root,  pith,  or  pulp  that  contains  starch  has 
been  tried  out  as  a  substitute  for  it,  because  these 
are  either  cheaper  in  proportion  to  their  starch  con- 
tent than  wheat  or  can  be  grown  in  climates  and  lati- 
tudes where  wheat  will  not  flourish.  Com  has  been 
tried  in  the  subtropics,  rice  in  the  tropics,  oats,  rye, 
and  barley  in  the  north  temperate  zone,  potatoes, 
sago  from  the  palm,  and  tapioca  from  the  manioc 
root. 

Only  the  net  result  can  be  given  here,  which  is 
that  no  civilized  nation  that  can  raise  the  money  or 
provide  the  transportation  to  get  wheat  will  allow 
its  army  to  live  on  any  other  yet  discovered  or  in- 
vented grain  or  starch.  Rice,  corn  meal,  potatoes, 
sago,  and  tapioca  are,  of  course,  ruled  out  at  once, 
because  they  contain  only  starch  and  nothing  to 
match  in  the  slightest  degree  the  twelve  or  fourteen 
per  cent  of  gluten,  or  vegetable  meat,  that  gives 
wheat  its  supreme  value. 

After  our  first  food  analyses  a  desperate  attempt 
was  made  to  substitute  corn  for  wheat,  because  it 


64  THE  DOCTOR  IN  WAR 

contained  from  five  to  seven  per  cent  of  protein,  — 
called  zein,  —  a  perfectly  good  protein  in  the  books 
and  in  the  laboratories ;  but  it  simply  would  not  work 
in  the  field.  Armies  fed  on  it  promptly  showed  signs 
of  nitrogen  starvation ;  and,  about  thirty  years  later, 
up  came  our  physiologist  with  the  belated  explana- 
tion that,  though  zein  was  a  right-enough  protein 
in  composition  and  chemical  structure,  only  about 
a  third  of  it  could  be  utilized  in  the  human  body. 

Even  the  purely  Oriental  nations  —  the  Japanese, 
Chinese,  and  Hindus  —  born  and  brought  up  on 
rice,  have  formally  abandoned  it  in  their  army  ration 
and  have  endeavored  to  substitute  wheat  for  it, 
though  expense  and  the  inborn  prejudices  of  their 
soldiers  have  proved  considerable  obstacles.  Troops 
or  nations  fed  on  rice  are  subject  to  beri-beri  and  are 
cured  by  a  diet  rich  in  protein,  either  vegetable  or 
animal,  wheat  or  meat.  Meat  and  wheat  in  the  ra- 
tion have  wiped  out  four  fifths  of  the  beri-beri  in  the 
Japanese  army  and  navy.  Those  fed  on  corn  be- 
come subject  to  pellagra,  which  is  ravaging  our  South- 
ern States  to-day. 

As  for  the  northern  grains,  barley,  rye,  and  oats, 
which  also  contain  some  gluten,  these  are  all  inferior 
to  wheat  —  rye  and  barley  on  account  of  their  low 
protein  content  and  considerable  bulk  of  innutritions, 
gelatinous,  and  gummy  materials,  which  disturb  the 
digestion ;  and  oats  on  account  of  the  irritating  bitter 


FEEDING  A  MILLION  MEN         65 

extractives  with  which  their  high  percentage  of  pro- 
tein is  combined.  Nobody  but  a  Scotchman  can  live 
on  oatmeal  as  his  sole  breadstuff;  and  it  has  taken 
generations  of  training  and  gallons  of  whiskey  on  the 
side  to  enable  even  him  to  do  it. 

The  successful  growth  and  colonization  of  the 
white  races  depend  principally  on  whether  wheat 
will  grow  in  the  climate  in  which  they  try  to  live. 
The  temperate  zone  is  simply  the  wheat  belt  and 
the  grass-and-beef  belt  —  the  only  region  in  the 
world  where  men  can  live  and  grow  without  suffer- 
ing from  nitrogen  starvation.  "Good  as  old  wheat!" 
is  an  even  higher  standard  of  praise  than  our  farmers 
realize. 

The  next  foundation  stone,  for  which  the  econo- 
mists endeavored  to  substitute  something  else,  just 
as  good  and  far  cheaper,  was  beef;  and  that  noble 
stand-by  holds  its  own  like  the  Rock  of  Gibraltar. 
No  other  kinds  of  meat  —  venison,  fowl,  game,  fish, 
or  other  animal  substances  —  would  take  its  place 
for  a  moment;  partly  because  they  are  lacking  in 
certain  elements  necessary  for  nutrition  and  partly 
because  they  contain  some  poisonous  flavoring  sub- 
stances, extractives  or  split  proteins,  which  promptly 
upset  the  digestion  and  the  health  when  they  are 
used  as  steady  articles  of  diet. 

Fish,  for  instance,  has  less  than  half  the  fuel  value 
of  its  own  weight  in  beef,  and  later  researches  have 


66  THE  DOCTOR  IN  WAR 

shown  that  half,  even  of  that  fuel  value  is  incapable 
of  digestion  in  the  human  stomach.  Chicken  and 
feathered  game  of  all  sorts  are  simply  trifles,  as  well 
as  extremely  expensive;  in  fact,  the  only  flesh  that 
can  for  a  single  month  or  even  week  be  substituted 
for  beef  is  pork. 

Several  years  ago  I  happened  to  meet  in  eastern 
Oregon  a  prosperous  and  successful  man  of  affairs 
who  in  his  youth  had  been  employed  by  the  Union 
Pacific  as  a  hunter  to  supply  its  construction  camps, 
when  building  the  railroad  across  the  Great  Plains, 
with  wild  meat  —  buffalo,  venison,  antelope,  and 
elk.  He  told  me  that,  at  first,  the  men  simply  reveled 
in  these  luxuries ;  but  that  after  the  first  week  or  so, 
if  they  were  compelled  to  go  for  a  single  week  or 
even  three  days  in  succession  without  their  pork  or 
beef,  they  threatened  a  mutiny.  He  summed  up  his 
experience  in  one  sentence:  **I  tell  you,  doctor, 
there's  only  one  meat  that's  fit  for  a  white  man  to 
live  on,  and  that's  beef,  with  pork  for  a  second 
choice." 

Any  one  who  has  been  on  an  extended  hunting  or 
exploring  trip  and  run  short  of  bacon  will  cordially 
indorse  this  remark.  The  finest  of  salmon  or  trout, 
of  venison,  partridge,  pheasant,  or  quail,  becomes  as 
sounding  brass  or  a  tinkling  cymbal  in  contrast  with 
plain  boiled  beef  or  fried  bacon. 

A  gentleman  who  had  acted  as  volunteer  cook  for 


FEEDING  A  MILLION  MEN         e^ 

a  hunting  party  of  his  friends  in  the  Olympics  of  the 
North  Pacific  Coast  told  me  he  could  fairly  cover 
the  camp  table  with  clams  and  broiled  salmon,  and 
fried  venison  and  roast  duck;  but,  after  the  first 
ten  days  out,  if  clams,  salmon,  venison,  and  duck 
were  the  only  things  on  the  board,  up  would  go  noses 
and  voices  at  once  in  the  complaint:  "What's  the 
matter  with  you?  Are  you  gettin'  too  lazy  to  cook 
a  little  bacon?" 

For  campaign  purposes,  as  an  indispensable  staple, 
bacon  is  perhaps  even  more  valuable  than  beef, 
because  it  is  twice  as  nutritious  in  proportion  to  its 
bulk,  will  keep  in  any  climate,  can  be  cooked  any 
old  way  and  yet  be  good,  may  be  dropped  in  tlie 
river,  run  over  by  an  ammunition  wagon,  rolled  on 
by  a  mule,  left  out  in  the  rain  all  night  or  in  the  sun 
all  day,  and  yet  be  perfectly  good  chuck  —  yes, 
"hyas  skookum  chuck "  in  the  Chinook  jargon; 
''heap  bully  good  grub"  —  when  cleaned,  trimmed, 
and  fried. 

Besides,  it  has  the  great  advantage  of  containing 
the  second  of  the  indispensable  elements  —  fat  —  as 
well ;  and  it  can  be  used  for  frying  or  as  shortening  in 
bread  or  biscuit.  Blessed  be  bacon!  Like  beef,  it 
boasts  the  one  great  and  only  unmistakable  earmark 
of  permanent  value  —  you  can  eat  it  once  a  day  all 
the  year  round  and  never  tire  of  it. 
^  As  for  any  of  the  vegetable  substitutes  for  meat, 


68  THE  DOCTOR  IN  WAR 

such  as  beans,  peas,  or  lentils,  to  know  them  is  to 
loathe  them.  They  are  rich  in  protein  and  very 
cheap;  but  alas!  they  contain  bitter  alkaloids  and 
extractives,  so  intimately  blended  into  their  proteins 
that  no  known  methods  of  steaming  or  cooking  will 
get  rid  of  them.  You  may  bake,  you  may  batter  the 
bean  as  you  will,  but  the  taste  of  the  horehound  will 
hang  round  it  still.  These  disagreeable  alkaloids  are 
not  only  bitter  but  poisonous,  upsetting  the  diges- 
tion and  impairing  the  health.  This  is  why  neither 
Tommy  Atkins  nor  his  American  cousin  will  stand 
for  pea-meal  sausage  in  the  emergency  ration,  though 
as  vegetables  and  for  variety  in  the  diet,  beans  and 
peas,  both  dried  and  canned  are  excellent;  and  the 
famous  pork-and-beans  can  be  used  as  solid  nutri- 
ment for  two  or  three  meals  a  week,  but  not  oftener. 
Boston  was  wise  —  as  usual  —  when  she  set  the  habit 
of  eating  her  sacred  beans  only  on  Saturday  night 
and  Sunday  morning. 

But  is  even  this  dietetic  trinity  of  bread,  beef  and 
sugar,  with  greens  and  dessert  on  the  side,  sufficient? 
The  results  of  a  hundred  campaigns  have  shown  that 
it  is  not.  Man  is  not  merely  a  stomach  and  muscles 
—  he  is  also  a  bundle  of  nerves;  and  they  require 
their  share  of  pabulum.  In  the  early  days  the  nerve- 
steadier  in  the  soldier's  diet  used  to  be  supplied  in 
the  form  of  grog  —  beer,  wine,  whiskey;  and  up  to 
about  one  hundred  years  ago  alcohol  in  some  form 


FEEDING  A  MILLION  MEN         69 

was  considered  to  be  an  absolutely  indispensable 
part  of  the  army  ration. 

Gradually,  however,  and  by  bitter  experience,  it 
was  realized  that  alcohol's  way  of  steadying  and 
supporting  the  nerves  was  to  narcotize  them,  which 
practically  means  poison  them ;  that  it  gave  no  nour- 
ishment to  the  body  and,  instead  of  improving  the 
digestion  and  utilization  of  food,  really  hindered  and 
interfered  with  them.  Man  must  have  something  to 
drink  as  well  as  to  eat;  but  what  can  be  found  as  a 
substitute? 

About  two  centuries  ago  two  new  planets  swam 
into  our  human  ken  above  the  dietetic  horizon  — 
tea  and  coffee.  They  were  looked  on  with  great  sus- 
picion at  first,  partly  because  they  were  attractive 
and  partly  because  they  were  new.  They  were  de- 
nounced by  the  Puritan  because  they  were  pleasant, 
and  by  the  doctor  because  they  were  not  in  the  phar- 
macopoeia; but,  in  spite  of  bitter  opposition,  they 
won  their  way. 

It  is  doubtful  whether  any  addition  to  the  com- 
fort of  civilized  man  within  the  last  two  hundred 
years  in  the  realm  of  dietetics  can  be  mentioned 
that  equals  them.  Certainly,  if  we  take  into  consid- 
eration the  third  new  article  of  food,  which  came  in 
and  still  goes  down  with  them  — •  sugar  —  it  would 
be  impossible  to  match  them  with  anything  of  equal 
value. 


70  THE  DOCTOR  IN  WAR 

Every  army  in  the  world  to-day  has  either  tea  or 
coffee,  or  both,  as  part  of  its  ration.  Their  advan- 
tages are,  briefly:  First,  they  probably  provide  the 
nerves  with  a  sort  of  ready-made  food  —  our  labora- 
tories have  not  discovered  this  fact  yet,  but  they 
will,  as  they  have  so  many  other  explanations  for 
and  justifications  of  what  our  instincts  knew  first. 
Second,  tea  and  coffee  add  enormously  to  the  at- 
tractiveness of  the  meal  and  to  our  ability  to  eat 
with  relish  and  appetite  large  amounts  of  solid  foods. 
No  matter  how  coarse  or  unattractive  the  ration, 
providing  it  has  decent  fuel  value,  if  it  is  trimmed 
and  washed  down  with  plenty  of  hot,  well-sweetened 
tea  or  coffee  it  will  fill  the  bill  and  keep  the  mess  in 
fighting  trim. 

Third,  —  and  this  is  a  very  important  point,  — 
they  unconsciously  lead  the  men  into  the  habit  of 
taking  the  greater  part  of  their  drinking-water 
boiled.  Not  only  is  tea  or  coffee  the  main  beverage 
at  mealtime,  but  the  men  get  into  the  habit  of  filling 
their  canteens,  before  starting  on  the  day's  march, 
with  cold  tea  or  cold  coffee,  and  thus  are  saved  in 
large  measure  from  the  temptation  of  drinking  from 
wells,  streams,  or  ponds,  and  thus  running  the  risk 
of  typhoid  or  cholera. 

It  was  the  opinion  of  both  the  American  and  the 
English  army  medical  men  who  accompanied  the 
Russian  and  Japanese  armies  in  their  late  war  that 


FEEDING  A  MILLION  MEN  71 

the  habit  of  drinking  hot  or  cold  tea,  almost  to  the 
exclusion  of  any  other  beverage,  was  largely  respon- 
sible for  the  surprisingly  low  typhoid  rate  that  ob- 
tained in  both  armies. 

Last,  but  by  no  means  least,  tea  and  coffee  have 
practically  driven  beer,  wine,  whiskey,  or  any  form 
of  alcohol  out  of  the  field.  Our  own  American  ration 
in  both  army  and  navy  includes  no  form  of  alcohol 
at  all,  but  only  tea  and  coffee.  Most  of  the  European 
rations  still  include  alcohol,  but  only  for  use  in  spe- 
cial emergencies,  such  as  the  chill  gray  dawn  in 
the  trenches ;  and  the  change  has  been  greatly  to  the 
benefit  of  the  soldier  physically,  mentally,  and  mor- 
ally. 

As  for  the  injurious  effects  alleged  to  be  produced 
by  tea  and  coffee,  the  explanation  appears  to  be  that 
they  belong  to  the  so-called  poison  foods,  those  curi- 
ous substances  which,  though  perfectly  wholesome 
and  harmless  for  ninety-nine  people  out  of  a  hundred, 
are  definitely  harmful  to  the  hundredth  man.  Some- 
where from  one  to  three  per  cent  of  the  community 
are  distinctly  injured  and  poisoned  by  tea  or  coffee, 
even  small  amounts  producing  burning  of  the  stom- 
ach, palpitation  of  the  heart,  headache,  eruptions 
of  the  skin,  sensations  of  extreme  nervousness,  and 
so  on,  though  the  remaining  ninety-seven  per  cent 
are  not  injured  by  them  in  any  appreciable  way  if 
consumed  in  moderation.    If  tea  or  coffee  poisons 


72  THE  DOCTOR  IN  WAR 

you,  let  it  alone.  But  for  heaven's  sake  have  the  grace 
to  be  ashamed  of  your  infirmity  and  don't  start  a 
crusade  to  prevent  normal,  healthy  people  from  hav- 
ing it  just  because  it  does  n't  agree  with  you.  Least 
of  all  try  to  foist  on  them  some  ghastly,  sloppy  sub- 
stitute like  post-mortem  serial  or  other  like  atrocities. 

Altogether,  the  army  ration  closely  approximates 
the  menu  of  a  well-supplied  private  home  table.  Not 
only  must  there  be  plenty  of  the  three  great  staples, 
—  bread,  meat,  and  sugar, — but  also  a  good  variety 
of  fruits,  vegetables,  puddings,  pies,  cakes,  and  other 
trimmings  of  various  descriptions.  Since  the  intro- 
duction of  sugar  in  commercial  amounts,  and  the 
consequent  development  of  methods  of  canning  and 
preserving,  the  average  modern  army  now  takes  the 
field  with  a  really  splendid  variety  of  canned  vege- 
tables, canned  fruits,  oysters,  canned  meats,  • —  par- 
ticularly in  the  form  of  canned  corned-beef  hash,  — • 
preserves  of  all  descriptions,  and  dried  fruits,  also 
chocolate  and  pure  candy  by  the  ton;  and  sets  for 
its  men  a  table  that  is  in  no  respect  inferior,  either  in 
nutrition  or  attractiveness,  to  that  of  the  average 
three-dollar-a-day  hotel. 

This  change  is  not  limited  or  confined  to  any  one 
nation  or  group  of  nations.  All  over  the  world,  where- 
ever  men  feed  and  fight,  their  commissariat  depart- 
ment endeavors  to  supply  them  with  substantially 
the  same  diet  and  trimmings.    The  amusing  super- 


FEEDING  A  MILLION  MEN         73 

stition,  for  instance,  eagerly  spread  about  by  our 
vegetarian  friends,  that  the  Japanese  army  in  its 
campaign  against  Russia  fought  on  a  diet  of  rice, 
vegetables,  and  salt  fish,  was  exploded  long  ago. 
For  thirteen  years  before  that  war,  and  in  deliber- 
ate preparation  for  it,  the  Japanese  army  and  navy 
had  been  living  on  a  ration  containing  beef,  wheat 
flour,  sugar,  pork,  butter,  and  apples,  modeled  as 
nearly  as  circumstances  and  convenience  would  per- 
mit on  that  of  the  English,  French,  and  American 
armies. 

It  is  true  that,  during  the  stress  of  the  campaign, 
the  supply  of  beef  fell  off  somewhat,  and  that  the 
newly  levied  troops  objected  to  eating  wheat  bread 
in  place  of  rice;  but  in  the  main  their  victorious  cam- 
paign was  fought  on  as  near  an  approximation  as 
was  practical  to  the  European  army  ration. 

The  same  curious  inflexibility  of  the  ration  has 
been  found  in  campaigns  in  tropical  climates.  When 
we  first  began  seriously  to  consider  and  scientifically 
to  study  our  foods,  it  was  customary  to  assume  that 
tropical  races,  having  lived  for  generations  in  tropi- 
cal climates,  had  gradually  hit  on  the  ideal  diet 
adapted  to  those  conditions.  So,  when  our  Northern 
soldiers  were  sent  into  Africa,  India,  Asia,  and  the 
Philippines,  an  attempt  was  made  to  get  them  to  live 
on  the  diet  of  rice,  fish,  and  vegetables  on  which  the 
natives  maintained  an  existence. 


74  THE  DOCTOR  IN  WAR 

It  was  supposed  that  a  hot  climate,  not  calling  for 
so  much  heat  production  on  the  part  of  the  body, 
made  a  lighter  and  less  nutritious  diet  advisable. 
And  the  frightful  mortality  which  often  affected 
Northern  European  troops  in  tropical  stations  was 
sometimes  attributed  .to  their  insisting  on  eating 
large  amounts  of  meat,  fat,  and  other  ''heating'* 
foods,  which  they  had  been  accustomed  to  eat  in 
their  home  climate. 

Two  facts,  however,  have  stood  out  from  the  very 
beginning  of  careful  study  of  this  matter:  First,  that 
at  least  ninety  per  cent  of  the  disease  and  mortality* 
particularly  of  the  intestines  and  liver,  which  had 
been  so  constantly  attributed  to  ill-chosen  food,  was 
due  to  infectious  disease;  and  that  the  moment  the 
germs  of  disease  were  excluded  the  mortality  and 
high  sickness-rate  almost  disappeared.  Screening 
the  windows,  draining  the  ponds,  and  filtering  the 
drinking  water,  for  instance,  cut  down  at  once  four 
fifths  of  the  tropical  diseases,  malaria,  typhoid,  chol- 
era, dysentery,  etc.,  to  which  our  Northern  troops  fell 
victims.  Food  had  absolutely  nothing  to  do  with  it, 
except  in  so  far  as  it  was  a  means  of  carrying  in- 
fection. * 

The  second  thing  was  that,  though  the  natives  of 
the  tropics  could  get  along  fairly  well  at  their  own 
level  of  living  and  rate  of  expenditure  of  energy  on 
their  tropical  diet,  the  moment  they  were  put  to  any 


FEEDING  A  MILLION  MEN         75 

task  that  called  for  strenuous  and  continued  exer- 
tion they  broke  down  at  once.  If,  however,  before 
they  were  called  on  to  do  white  men's  work,  whether 
as  native  troops  or  as  laborers  on  railroads,  canals, 
and  so  on,  they  were  put  for  a  couple  of  weeks  on  a 
full  white  man's  ration,  the  breakdown  did  not  take 
place. 

It  has  now  been  shown  in  every  climate  in  the 
world  —  most  strikingly  in  the  building  of  our  Pan- 
ama Canal  —  that  native  laborers,  placed  on  the  full 
Northern  army  ration,  plenty  of  beef,  pork,  sugar, 
and  wheat  bread,  would  increase  their  working 
power  twenty-five,  thirty-five,  or  fifty  per  cent 
within  six  months;  and  at  the  same  time,  instead  of 
developing  stomach  and  liver  disease  from  over- 
eating, they  would  become  healthier  and  stronger 
and  less  subject  even  to  the  tropical  infections  among 
which  they  live. 

In  other  words,  tropical  races  live  on  a  diet  of  rice 
and  vegetables  for  one  reason,  and  only  one,  and 
that  is  poverty  —  which,  by  the  way,  is  the  only  real 
cause  for  any  of  the  spare  and  exclusive  diets  of 
mankind  in  any  part  of  the  world.  The  minute  the 
most  famous  vegetarian  races  can  get  their  hands 
on  meat  and  fat,  they  devour  them  eagerly  and  im- 
prove enormously  in  both  working  power  and  health. 

The  tropical  ration  for  European  or  American 
armies  now  consists  of  practically  the  same  staples 


76  THE  DOCTOR  IN  WAR 

that  are  used  in  the  North,  with  a  little  less  meat  on 
account  of  its  power  of  raising  the  body  temperature, 
a  little  less  fat,  and  somewhat  larger  amounts  of 
sugar,  fruits,  and  vegetables.  If  the  army  is  to  take 
the  field  and  make  forced  marches,  climb  mountains, 
wade  rivers,  and  lie  out  in  the  open,  it  requires  just 
as  full  and  abundant  a  ration  of  meat,  fat,  and  wheat 
bread  as  it  does  during  a  Northern  campaign  in  a 
temperate  climate. 

A  large  share  of  the  alleged  indolence,  fatalism, 
and  lack  of  energy  in  the  peoples  of  the  tropics  is 
due  to  the  fact  that  they  are  underfed,  and  partic- 
ularly starved  of  protein,  and  the  balance  to  malaria 
and  hookworm.  Plenty  of  meat  or  other  protein, 
mosquito  nets,  spades,  and  drain  tiles  will  enable  the 
white  race  to  colonize  any  part  of  the  tropics,  pro- 
vided some  mountain  resort  can  be  brought  within 
striking  distance  by  rail,  where  the  women  and  chil- 
dren may  be  sent  during  the  heated  season  and  the 
men  may  spend  two  months  or  more  out  of  each 
year,  assisted  by  proper  travel  and  vacations  in  tem- 
perate climates. 

Not  only  does  the  most  scientific,  up-to-date  army 
ration  match,  as  to  its  composition,  the  kind  that 
mother  used  to  cook,  but  it  is  approaching  it  as  rap- 
idly as  possible  in  methods  of  cooking  and  serving. 
In  an  early  day  each  soldier  carried  not  only  his  food- 
supply  but  also  his  cooking  utensils  on  his  back  or 


FEEDING  A  MILLION  MEN         ^^ 

at  his  saddlebow,  squatted  down  in  the  dirt,  and  Ht- 
erally  ''messed"  for  himself. 

Echoes  of  that  Golden  Age  still  linger;  and  even 
in  textbooks  on  military  hygiene  you  will  find  re- 
gretful allusions  to  the  days  when  the  Scotch  Bor- 
derer rode  down  from  the  Grampians  on  his  shaggy 
pony,  with  a  bag  of  oatmeal,  a  little  salt,  and  a 
sheet-iron  griddle-plate  hanging  at  his  saddle  for  his 
entire  commissariat  department;  or  to  the  famous 
Arab  cavalry,  which  would  start  on  a  three  weeks* 
campaign  with  a  bag  of  parched  barley  on  one  side 
of  the  saddle  and  one  of  dried  dates  on  the  other. 

These  gentle  adventurers  expected  to  steal  most  of 
their  food ;  but,  though  they  could  make  a  campaign 
after  a  sort  on  such  chicken  feed,  they  could  not 
have  stood  up  before  a  modern  bayonet  charge  for 
two  minutes  on  any  such  trash.  If  they  happened 
to  be  kept  in  the  field  for  more  than  three  or  four 
weeks  three  quarters  of  them  never  went  home,  but 
died  of  typhoid,  cholera,  dysentery,  and  other  filth 
diseases. 

The  modern  soldier,  of  course,  still  carries  his 
mess-tin,  pannikin,  knife,  fork,  and  spoon;  and  the 
things  he  cannot  cook  and  eat  with  this  excellent 
rough-and-ready  outfit  would  make  a  very  short  list 
indeed.  The  mess-tin  is  a  particularly  admirable 
utensil  of  oval  shape,  about  the  size  and  depth  of  an 
ordinary  pie  tin,  made  of  the  thickest  block  tin, 


78  THE  DOCTOR  IN  WAR 

which  means,  of  course,  sheet  iron  thickly  plated 
with  tin.  It  has  a  lid  or  cover  and  also  a  handle, 
hinged  to  it,  which  can  be  folded  over  it  when  it  is 
closed.  Put  on  the  cover  and  you  have  a  good  small 
Dutch  oven  or  baking-dish,  which  can  be  buried  in 
the  coals;  straighten  out  the  handle  and  you  have 
an  excellent  frying-pan,  in  which  both  biscuits  and 
bread  can  also  be  cooked. 

The  pannikin,  or  cup,  is  made  in  one  piece,  also 
of  the  heaviest  block  tin,  holds  more  than  a  pint, 
has  a  folding  handle  and  will  boil  anything  that  can 
be  boiled,  from  coffee  and  tea  to  beans  and  onions  — • 
except,  of  course,  rice  as  tackled  by  the  raw  recruit. 
A  classic  story  is  told  of  a  green  soldier  who,  finding 
a  pound  of  rice  in  his  ration,  proceeded  to  cook  it  for 
supper.  He  poured  it  all  into  his  quart  cup,  covered 
it  with  water,  and  put  it  on  to  boil.  When  it  started 
to  swell  it  began  to  erupt  gently  and  flow  over  the 
side  of  the  cup  into  the  fire.  In  alarm  he  spooned  out 
the  top  layer  into  his  tin  plate;  but  the  can  was  full 
again  before  he  could  turn  around.  Next  he  ladled 
his  frying-pan  full,  and  then  filled  his  tin  cup.  Then 
he  filled  the  pie  tin  and  the  water  dipper,  until 
finally  every  utensil  in  camp  was  full  to  the  brim. 
Still  the  rolling  flood  of  rice  pudding  rose  and  swelled 
and  majestically  overflowed. 

Inside  the  mess  tin  are  three  canvas  bags  for  salt, 
sugar,  and  coffee;  and  in  the  haversack  there  is  a 


FEEDING  A  MILLION  MEN         79 

ration  of  bacon,  bread,  and  beans.  This  outfit  is  in- 
tended only  to  make  the  soldier  self-supporting  for 
a  few  days,  or  a  week  at  the  outside,  when  he  leaves 
his  baggage  wagons  behind  or  is  separated  from  them. 
The  plan  now  is  to  cater  and  cook  for  an  army  in 
the  field  almost  as  carefully  and  in  as  appetizing  a 
manner  as  in  garrison  or  at  home.  Instead  of  divid- 
ing the  men — on  the  ancient  and  venerable  method 
that  was  one  of  Sparta's  contributions  to  the  art  of 
war  —  into  messes  of  eight  or  ten,  one  of  whom  would 
volunteer  or  be  commandeered  as  cook,  — •  which 
was  probably  the  origin  of  the  classic  epigram,  "God 
sends  meat,  and  the  Devil  sends  cooks!"  —  the  unit 
of  the  cook  supply  is  either  the  company,  as  in  the 
United  States  Army,  or  the  battalion,  as  in  most 
European  armies. 

The  army  cook  is  a  well-paid,  trained  expert,  who 
has  either  learned  his  profession  in  private  life  or  been 
sent  to  one  of  the  old  schools  of  cookery  maintained 
by  the  army.  The  United  States  Army,  for  instance, 
had  three  of  these  —  one  in  the  East,  one  in  the 
South,  and  one  in  the  West.  He  has  for  his  company 
—  ranging  from  sixty  men  in  time  of  peace  to  one 
hundred  or  one  hundred  and  ten  on  a  war  footing  — - 
a  staff  of  from  one  to  three  assistants,  two  cook's 
police,  and  a  helper  or  two. 

In  the  early  days  a  cook  had  to  be  an  inventor  as 
well  as  a  mechanic;  and  stories  are  still  told  of  famous 


8o  THE  DOCTOR  IN  WAR 

army  cooks  who  could  make  bread,  ready  to  eat 
within  twenty-five  minutes,  out  of  flour  in  the  barrel, 
without  pans,  cooking  utensils,  range,  or  stove.  Their 
method  was  to  knock  in  the  head  of  the  barrel; 
scoop  a  hole  in  the  top  of  the  flour,  pour  into  this 
hole  water,  with  salt  and,  if  available,  baking  powder 
or  yeast;  mix  up  the  dough  in  this  flour-lined  knead- 
ing pan  and  pat  it  into  flat  cakes,  knock  one  or  two 
barrels  apart,  sharpen  the  staves  at  both  ends,  cut 
them  in  two,  stand  the  dough  cakes  before  a  roaring 
fire  on  these  shingles,  and,  when  done  on  one  side, 
turn  over  and  roast  on  the  other. 

To-day,  however,  the  army  cook  takes  the  field 
with  a  portable  sheet-iron  stove,  into  which,  tele- 
scoping into  one  another,  fits  a  full  equipment  of 
pans,  kettles,  boilers,  and  dishes  of  all  sorts.  This 
stove  is  quickly  set  up ;  the  pans,  as  emptied  out,  are 
passed  round  to  his  helpers;  and  within  thirty  min- 
utes he  has  a  full  outdoor  kitchen  improvised,  that 
needs  only  an  awning  stretched  over  it  to  make  a 
regular  cookhouse. 

Most  of  the  present  armies,  notably  the  English, 
go  farther  than  this,  and  have  regular  portable  kitch- 
ens or  cooking-stoves  mounted  on  wheels  and  drawn 
by  one  or  two  horses,  or  driven  by  motors,  which 
accompany  each  battalion  in  the  field.  These  kitch- 
ens are  provided  not  merely  with  a  fire-box  and 
cooking-utensils,  but  also  water- tanks  and  caldrons 


FEEDING  A  MILLION  MEN         8i 

with  waterproof  lids,  which  can  be  screwed  down  so 
that  a  meal  can  be  started  before  breaking  camp  and 
continue  cooking  while  on  the  march.  The  moment 
the  army  stops,  all  that  is  necessary  is  to  take  off  the 
lids  and  serve  the  soldiers  a  hot,  steaming  meal. 

These  portable  kitchens  also  have  the  great  ad- 
vantage of  keeping  the  army,  while  on  the  march, 
constantly  supplied  with  hot  water  from  which  tea, 
coffee,  soups  or  broths  may  be  made. 

The  United  States  Army  now  provides  a  capital 
special  manual  for  army  cooks,  which  gives  careful 
directions  for  the  most  appetizing  and  attractive 
methods  of  cooking  the  different  elements  of  the 
ration  and  the  best  ways  of  serving;  insists  on  the 
most  scrupulous  care  in  keeping  dishes  and  utensils 
of  every  sort  spotlessly  clean  and  sweet,  and  so  on. 
Complete  and  most  appetizing  recipes  are  included 
for  mincemeat,  lemon  pie,  ice-cream,  pineapple  ice, 
corn  fritters,  layer  cake,  crullers,  potato  salad,  clam 
chowder,  crab-meat  stew,  and  other  things  that 
fairly  make  the  mouth  water. 

The  elaborateness  of  providing  and  serving  the 
army  ration  is  not  a  sign  of  the  growth  of  luxury  or 
effeminacy  — ■  it  is  a  matter  of  the  highest  economy 
and  best  possible  strategy,  as  well  as  of  investment; 
because  men  will  march  better,  fight  better,  drink 
and  dissipate  far  less  on  an  abundant,  varied,  well- 
cooked,  hot,  and  attractively  served  diet  than  they 


82  THE  DOCTOR  IN  WAR 

will  on  bacon  and  hard-tack  cooked  in  the  ashes  — 
which  means  in  the  dirt  —  and  served  on  sticks  or 
slabs  of  bark. 

Everybody  who  has  had  experience  in  camping 
knows  that  camp  cookery  and  men-folks'  amateur 
cookery  generally  are  simply  a  dirty  and  rather  dis- 
agreeable form  of  mitigated  starvation.  It  is  all  very 
well  to  live  on  camp  diet  when  you  are  simply  loaf- 
ing and  amusing  yourself;  but  when  you  try  to  work 
on  it  it  soon  blows  up  —  or,  rather,  you  do.  Lumber 
camps,  railroad  gangs,  and  engineering  camps  of 
every  sort  and  description  now  give  as  rich,  liberal, 
varied,  and  well-cooked  a  diet  as  can  be  found  any- 
where in  civilization — ^not  out  of  philanthropy, 
but  because  it  pays. 

One  of  these  days  a  nation  or  a  community  at 
peace  will  study  its  food-supply,  arrange  for  its 
proper  production  in  the  most  appropriate  soils  and 
climates;  its  shipment  with  the  greatest  economy  of 
movement  and  least  possible  expense;  its  handling 
and  storage  with  the  highest  degree  of  cleanliness  and 
economy;  and  its  distribution  to  the  consumer  in 
good  condition  and  at  a  low  price  —  in  the  same  way 
that  an  army  commissariat  department  now  sup- 
plies its  troops.  When  it  does  this  we  shall  see  an 
increase  in  national  efficiency,  in  working  power,  in 
health,  and  in  happiness  of  at  least  thirty-five  per 
cent  within  thirty  years. 


IV 

THE  SUPERB  HEALTH  OF  THE  ARMIES 

I  HAD  the  good  fortune  to  be  in  Paris  on  the  14th 
of  July,  France's  National  Day,  which  she  keeps 
as  religiously  as  we  do  our  beloved  Fourth.  It  was 
celebrated  this  year  (19 17),  by  a  great  review  of 
troops  at  the  Cour  de  Vincennes,  not  sham-battle 
soldiers,  but  real  ones — veterans  of  nearly  three  years 
of  fierce,  incessant  campaigning. 

New  colors  were  presented  by  the  President  of  the 
Republic  to  some  sixty  regiments  that  had  distin- 
guished themselves  on  the  Field  of  Honor.  Each 
regiment  sent  up  a  company  to  receive  its  trophies 
and  serve  as  a  guard  of  honor,  and  then  to  march 
proudly  through  the  crowded  and  cheering  streets  of 
Paris,  bearing  their  new  colors,  making  a  total  of 
over  eight  thousand  men  in  line.  It  was  one  of  the 
most  magnificent  and  cheering  spectacles  I  have  ever 
seen  —  not  merely  from  a  patriotic  and  fraternal 
point  of  view,  but  also  from  a  physical  and  scientific 
one. 

It  would  be  impossible  to  imagine  a  more  continu- 
ous and  unbroken  stream  of  splendid  health  and 
physical  vigor  and  endurance  than  these  war-worn 
veterans  presented.   After  the  storms  of  blood  and 


84  THE  DOCTOR  IN  WAR 

fire  and  shell  rain  and  poison  gas  which  they  had  been 
through;  after  the  magnificent  fight  that  they  had 
kept  up  for  almost  three  years,  in  the  beginning 
against  overwhelming  odds,  one  might  well  have 
expected  to  see  faces  lined  and  worn,  eyes  sunk  and 
grave,  though  bravely  resolute,  shoulders  a  little 
bowed  by  the  burden  of  the  years  of  war.  But  here 
they  came  —  these  heroes  of  a  hundred  bloody  at- 
tacks and  counter-attacks,  these  veterans  of  Ver- 
dun, of  the  Marne,  of  the  Somme,  with  the  bright 
eyes,  the  fresh  color,  the  cheerful  smile,  the  free  elas- 
tic gait,  of  a  band  of  college  students  celebrating  a 
football  triumph.  The  eyes  were  steadier,  the  jaws  a 
little  squarer,  the  whole  set  of  the  face  and  carriage 
more  purposeful  and  dignified,  but  for  sheer  splen- 
did joy  of  living  and  fearless  sense  of  readiness  and 
fitness  for  an3^hing,  they  could  not  have  been  sur- 
passed by  any  intercollegiate  team  of  athletes.  They 
had  seen  the  horrors  of  war,  they  had  looked  death 
in  the  face  a  thousand  times,  but  it  had  neither  sad- 
dened nor  depressed  them. 

I  looked  about,  right  and  left,  at  the  faces  that 
lined  the  street  on  either  side  and  behind  me  — 
faces  for  the  most  part  of  sturdy,  vigorous,  laboring 
people,  who  had  come  in  from  the  outer  suburbs  and 
surrounding  country  for  the  great  event.  I  passed  in 
review,  before  my  mind's  eye,  the  crowds  who  would 
throng  the  streets  at  home  on  a  like  celebration. 


THE  HEALTH  OF  THE  ARMIES     85 

And  it  would  have  been  utterly  impossible  to  have 
picked  out,  from  even  the  most  vigorous  and  hard- 
working of  peaceful  spectators,  any  such  body  of 
joyous,  clean-drawn  athletes  as  were  marching  in 
horizon-blue  uniform  and  steel  helmets,  with  shining, 
fixed  bayonets  down  the  street. 

The  day  was  close  and  sultry,  the  streets  jammed 
and  packed  with  a  perspiring  crowd.  The  place 
where  I  stood  was  a  good  two  miles  and  a  half  from 
the  review  ground,  and  the  men  were  marching  in 
full  field  uniform,  with  long,  heavy  overcoats,  great 
steel  helmets  on  their  heads,  with  rifles,  fixed  bayo- 
nets, and  ammunition  belts.  Yet  they  fairly  danced 
along,  as  if  they  were  enjoying  it,  every  foot  of  it. 
It  was  one  of  the  most  magnificent  and  cheering 
demonstrations  of  the  everlasting  resiliency,  the 
utter  irrepressibleness  of  the  human  physique  and  of 
the  human  spirit. 

If  any  one  imagines,  as  would  not  be  unnatural, 
that  three  continuous  years  of  the  hell  of  week-long 
bombardments  and  of  the  bitter  and  unheard-of 
hardships  of  the  trenches  must  have  worn  the  nerves 
and  wearied  the  spirits  of  the  long-suffering  army, 
one  good  look  at  the  ruddy,  cheerful  faces,  the  broad, 
square  shoulders,  straight  backs,  and  lithe,  elastic 
limbs  of  those  joyously  marching  columns  would  be  a 
convincing  revelation  to  the  contrary. 

Incidentally,  on  the  other  hand,  though  this  is  not 


86  THE  DOCTOR  IN  WAR 

perhaps  sticking  strictly  to  the  professional  last,  it 
did  one  good  to  see  how  the  temper  and  spirit  of  the 
crowd  met  and  matched  that  of  the  fighting  men. 
Everywhere  shone  the  same  high  courage,  the  same 
proud  endurance,  the  same  confidence  of  ultimate 
victory.  Though  the  brave,  sad  eyes  of  the  women 
haunted  one  at  every  turn,  and  a  plain  black  band  on 
many  a  coat-sleeve  told  of  bitter  bereavement,  yet 
the  memories  of  their  sacrifices  simply  strengthened 
and  deepened  their  pride  and  joy  in  the  splendid 
army  which  they  had  put  in  the  field  and  were  sup- 
porting there,  and  hardened  their  determination  to 
continue  the  slowly  but  surely  winning  fight  to  final 
triumph. 

Nor  is  this  cheering  condition  confined  to  the  crack 
or  picked  regiments.  I  have  seen  hundreds  of  regi- 
ments, thousands  of  platoons,  in  their  camps,  on  the 
exercise  grounds,  marching  along  the  roads,  going  up 
to  or  coming  back  from  the  trenches  at  the  front, 
changing  lines  from  one  army  to  another,  entraining 
and  detraining  at  the  great  railroad  stations,  and 
never  have  I  seen  anywhere,  in  forty  years*  careful 
and  affectionate  observation  of  the  genus  humanum 
in  time  of  peace,  such  a  vigorous,  free-moving,  clear- 
eyed,  fresh-colored  set  of  athletes  in  the  literal  "pink 
of  condition*'! 

The  thing  is  so  universal  that  it  is  overwhelming  — 
from  Sheffield  to  Soissons,  from  Melbourne  to  Mes- 


THE  HEALTH  OF  THE  ARMIES     87 

sines,  the  shock  of  sheer  pleasure,  to  the  eye  of  the 
physical  trainer,  from  the  swinging  ranks  of  every 
regiment  that  one  sees  on  the  march.  One  gets  actu- 
ally to  look  out  for  the  exceptions,  to  think  of  each 
rippling  line  of  horizon-blue  or  khaki  that  one  meets 
streaming  down  one  side  of  the  crowded  road,  while 
the  flood  of  artillery  and  transport  pours  past  along 
the  other,  ^'This  one  is  going  to  be  the  exception  — 
here  come  the  misfits,  that  have  been  kept  in  the 
background  —  these  men  will  show  the  combings  of 
conscription  or  the  hardships  of  the  trenches,  the 
nerve-strain  of  the  thundering  bombardments." 
But  each  time  you  are  agreeably  disappointed. 

Ruddy,  sweating,  and  leaning  well  into  their  pack- 
straps,  caked  with  mud  or  powdered  with  dust,  still 
they  were  covering  the  ground  easily,  and  in  work- 
manlike fashion,  from  the  hips,  heads  up,  eyes  bright, 
foreheads  unwrinkled.  Cheerful,  smiling,  often  sing- 
ing, or  guying  one  another,  or  playing  practical  jokes 
as  they  tramped  along,  rippling  from  head  to  heel 
with  the  sheer  joy  of  physical  fitness  and  vigor,  the 
glory  of  the  flesh  —  they  looked  as  if  they  had  not  a 
care  in  the  world,  and  were  ready  for  anything,  like 
Landor's  heroes  of  old  Greece,  "Who  with  a  frolic 
welcome  met  the  thunder  and  the  sunshine." 

The  armies  in  France  to-day  (19 17),  including  our 
splendidly  conditioned,  lean,  wiry,  and  sunburnt 
boys  from  the  Mexican  border,  are  a  triumph  of 


88  THE  DOCTOR  IN  WAR 

what  can  be  accomplished  by  intelligent,  united 
physical  training,  splendid  feeding,  and  the  most 
watchful  and  expert  of  sanitary  care.  So  superbly 
has  the  combination  worked  that  the  men  in  the 
camps  and  in  the  trenches  have  actually,  outside,  of 
course,  of  battle  casualties  and  wounds,  a  lower  dis- 
ease-rate and  a  far  lower  death-rate  from  disease 
than  the  armies  of  the  respective  countries  have  in 
their  barracks  in  time  of  peace,  and  of  course  far 
below  that  of  the  average  civil  population.  Even 
through  the  awful  weather  of  last  winter  —  the  worst 
in  twenty  years,  not  merely  coldest,  but  stormiest  — 
when  flooding  rain  and  driving  sleet  and  bitter  frost 
and  whirling  snow  alternated  with  one  another 
against  a  background  of  bottomless,  stinking  mud 
right  up  to  the  middle  of  April,  I  found  actually  less 
influenza  and  sore  throat,  pneumonia  and  bronchitis, 
in  the  trenches  than  there  were  in  Paris  or  London  or 
New  York. 

Still  more  unexpected  and  incredible,  all  through 
one  of  the  savagest  and  severest  winter  campaigns 
ever  fought,  under  an  unprecedented  strain  of  con- 
tinuous exposure  to  the  elements  in  their  most  bit- 
ter and  vicious  forms,  one  of  the  longest  and  most 
grueling  endurance  runs  to  which  the  human  auto- 
mobile has  ever  been  submitted,  there  was  less 
rheumatism  than  in  a  great  city  hospital  during  the 
same  months.    In  fact,  the  disease  was  astonish- 


THE  HEALTH  OF  THE  ARMIES     89 

ingly  rare  and  most  of  it  of  the  so-called  muscular 
variety. 

How  has  this  splendid  and  lasting  physical  perfec- 
tion of  the  fighting  man,  this  capacity  to  rise  superior 
to  all  the  strange  and  unexpected  stresses  and  hard- 
ships of  modern  war,  been  brought  about?  Simply 
by  that  infinite  capacity  for  taking  pains  which  Buf- 
fon  declared  was  genius.  From  the  day  that  the  new 
recruit  first  joined  the  colors,  every  detail  of  his 
clothing,  his  equipment,  his  feeding,  his  housing,  his 
physical  training,  his  protection  against  disease,  has 
been  taken  over  and  watched  with  sleepless  care, 
according  to  most  carefully  thought-out  and  tested 
plans. 

A  staff  —  literally  an  army  in  itself  —  of  the  ablest 
and  most  carefully  selected  experts  in  sanitation,  in 
food-supply,  in  engineering,  in  physical  training,  and 
in  medicine,  has  been  brought  together  for  this  from 
all  the  resources  of  civilization.  His  food,  the  famous 
army  ration,  represents  the  experience  of  years  and 
the  labors  of  commission  after  commission,  not  merely 
of  practiced  campaigners,  but  of  physiologists,  food 
experts,  chemists.  Its  amount,  its  constituents,  its 
proportions,  and  its  variety  have  been  determined 
almost  regardless  of  considerations  of  expense,  sim- 
ply for  the  purpose  of  supplying  the  human  machine 
with  the  most  abundant  and  effective  and  strength- 
supporting  supply  of  fuel  possible  which  is  available 


90  THE  DOCTOR  IN  WAR 

in  sufficient  amounts  in  the  field  and  reasonably 
capable  of  transportation. 

No  college  athletes'  training-table  serves  any- 
thing better  from  the  point  of  view  of  actual  need  for 
vigor,  efficiency,  and  endurance  than  the  modern 
army  ration,  particularly  our  own  and  that  of  Eng- 
land. Its  only  weakness,  which,  of  course,  is  inher- 
ent in  all  army  rations,  is  in  point  of  variety  and 
elasticity,  so  to  speak,  particularly  in  the  more  per- 
ishable accessory  foods  such  as  fresh  vegetables, 
fresh  fruits,  eggs,  milk,  etc.  But  these  in  this  war 
have  been  very  largely  made  good  by  canteens, 
Y.M.C.A.  "huts,**  with  their  caf6s,  and  the  judi- 
cious patronage  and  encouragement  of  "local  indus- 
tries." There  is  scarcely  another  diet  in  the  land, 
even  in  the  most  luxurious  and  expensive  private 
tables  which  is  chosen  so  solely  with  an  eye  to  vigor 
and  health  and  with  so  little  regard  to  expense  in  the 
essentials. 

Every  detail  of  the  fighting  man's  clothing,  the  cut 
and  texture  of  his  uniform,  his  underwear,  the  qual- 
ity of  his  socks,  the  shape  of  his  shoes,  is  the  product 
of  generations  of  patient  and  unwearied  study  and 
experiment.  Just  to  take  one  detail:  The  new  army 
shoe  of  the  United  States  Army  is  one  of  the  most 
perfect  and  practical  specimens  of  human  footwear 
anywhere  to  be  found,  and  the  report  of  the  commis- 
sion of  army  surgeons  headed  by  Major  Munson, 


THE  HEALTH  OF  THE  ARMIES     91 

which  recommended  it,  is  one  of  the  ablest  and  most 
authoritative  documents,  in  Hterature,  upon  shoes 
and  their  structure  and  the  care  and  protection  of 
the  feet. 

The  site  for  his  training  camp  is  selected  with  the 
greatest  care,  usually  upon  rolling,  porous  ground 
with  good  natural  drainage  and  exposure ;  it  is  care- 
fully drained  both  surface  and  deep,  supplied  with 
perfect  water  and  a  system  of  sewers;  in  fact,  many 
of  the  more  favorably  situated  sites  might  be  easily 
described  without  any  exaggeration  as  military 
health  resorts.  He  is  housed  —  not  merely  in  the 
training  camp,  but  usually  also  in  the  field,  on  ac- 
count of  one  of  the  redeeming  features  of  trench 
warfare,  its  comparative  stationariness  —  in  com- 
fortable wooden  barracks  called  huts,  planned  for 
protection  and  warmth  combined  with  ventilation. 
His  washing  is  tciken  care  of,  either  by  the  hard- 
working and  competent  women  of  the  neighboring 
country,  or  in  the  camps  and  in  most  places  on  the 
front  by  great  steam  laundries  capable  of  handling 
thousands  of  garments  per  hour  which  are  installed 
at  some  convenient  point  toward  the  base,  for  each 
army. 

He  has  not  only  the  best  and  promptest  of  medical 
attention,  but  splendid  hospital  care  if  he  falls  sick. 
Every  possible  precaution,  however,  is  taken  to  pre- 
vent the  possibility  of  the  development  of  disease  or 


92  THE  DOCTOR  IN  WAR 

exposure  to  infection.  Each  large  army  area  has  not 
merely  its  regimental  doctors  and  hospital  surgeons 
and  physicians,  but  a  visiting  sanitary  inspector, 
with  a  staff  of  sanitary-service  men  in  each  camp 
who  devote  their  entire  time  to  inspecting  and  keep- 
ing up  to  the  mark  all  the  sanitary  arrangements  of 
the  camps. 

In  most  camps  every  particle  of  refuse,  of  night 
soil,  of  garbage  that  cannot  be  utilized,  is  not  only 
collected  with  the  most  scrupulous  care  and  cleanli- 
ness, but  completely  destroyed  by  burning,  which 
ends  at  once  all  possibility  of  its  ever  getting  into  the 
water-supply,  or  fouling  new  camp  sites,  or  reappear- 
ing in  any  possible  way  to  cause  trouble  in  the  future. 
All  the  manure  from  the  cavalry  and  transport  lines 
is  either  spread  upon  the  land  at  once,  often  by  the 
thrifty  farmers  of  the  neighborhood,  or  else  burnt. 
This  burning  process  calls  for  a  good  deal  of  trouble 
and  skill,  but  it  has  another  tremendous  advantage 
in  camp  hygiene,  that  it  robs  our  most  intimate 
enemy  and  pest,  the  fly,  of  most  of  his  hope  of  exist- 
ence, by  depriving  him  of  both  pasturage  and  breed- 
ing-grounds. This  is  supplemented  by  a  vigorous 
anti-fly  campaign,  with  the  result  that  a  large  pro- 
portion of  our  camps  on  the  Western  Front  are  com- 
paratively free  from  the  plague  of  flies,  which  means 
that  two  thirds  of  the  risks  of  diarrhoea  and  d3^sen- 
tery  are  wiped  out  at  one  stroke,  and  accounts  for  a 


THE  HEALTH  OF  THE  ARMIES     93 

really  astonishing  scarcity  on  the  Western  Front  of 
both  these  typical  army  diseases.  And  the  head  of 
the  list  in  this  triumph  of  sanitation  and  cleanliness 
is  held  by  the  Italian  army  camp  and  hospitals. 

The  wonderful  protection  against  typhoid  secured 
by  vaccination  is  now  a  household  word.  The  high 
feeding  and  good  housing  and  ventilation,  with  the 
open-air  life,  give  almost  sanatorium  conditions 
against  tuberculosis  as  well  as  against  pneumonia 
and  bronchitis. 

In  fine,  I  have  no  hesitation  in  asserting,  on  the 
basis  of  a  fairly  extensive  sanitary  experience  on  both 
sides  of  the  Atlantic,  that  I  know  very  few  cities  in 
the  world,  even  those  that  pride  themselves  on  the 
perfection  of  their  health  departments,  which  are 
kept  in  as  good  sanitary  condition,  with  as  little  dis- 
ease, as  are  the  majority  of  our  camps  on  the  Western 
Front.  So  that  the  father  and  mother  who  give  their 
boy  for  the  defense  of  his  country  may  have  at  least 
the  consolation  and  satisfaction  of  knowing  that  the 
only  risks  that  he  will  run  are  the  necessary  and  insep- 
arable perils  of  the  battle-field  itself.  It  is  hardly  too 
much  to  say  that  nowhere  in  the  world  to-day  are 
bodies  of  young  men  maintained  under  better  and 
wholesomer  hygienic  —  yes,  and  moral  and  intellec- 
tual —  surroundings  and  influences  than  the  soldiers 
on  the  battle-fronts  of  Western  Europe.  Those  who 
survive  the  sad  and  inseparable  crowning  risks  of 


94  THE  DOCTOR  IN  WAR 

battle,  death,  or  permanent  disability,  which  will  not 
exceed  all  told  three  per  cent  per  annum,  will  have 
had  a  training  and  improving  of  their  physique,  a 
quickening  and  broadening  of  their  intellect,  which 
will  be  an  endowment  and  valuable  education  for 
any  field  of  future  work  and  a  permanent  benefit  to 
them  through  after  life. 


V 

THE  LAND  OF  THE  HAPPY  WARRIOR  AND 
THE  CHEERFUL  WOUNDED 

HE  jests  at  scars  who  rests  on  a  CCS.  pillow. 
Of  course  everybody  knows  what  a  ^'CCS." 
is  —  or  if  they  don't,  they  ought  to,  because  it  is 
about  the  biggest  thing  that  has  happened  since  the 
beginning  of  this  war  in  the  way  of  humanity  and 
helpful  science.  '*CCS.,"  in  chilly,  laconic,  official 
speech,  means  "Casualty  Clearing-Station."  But  to 
hundreds  of  thousands  of  our  brave  wounded,  it 
means  far  more  than  that.  To  them  the  three  magic 
letters  stand  for  a  little  hospital  heaven  here  upon 
earth,  ease  after  agony,  rest  after  torment,  cleanness 
and  coolness  and  comfort,  after  mud  and  filth  and 
carnage,  Elysium  after  Tophet. 

A  Casualty  Clearing-Station  is  a  little  first-class 
city  hospital  on  the  pavilion  plan,  all  complete  with 
every  modern  convenience:  full  staff  of  surgeons, 
nurses,  orderlies,  X-Ray  Room,  Bacteriological  Lab- 
oratory, hot  and  cold  water,  electric  light  —  dropped 
down  on  the  field  of  war  within  five  or  ten  miles  of 
the  firing-line.  Not  so  very  little  either,  for  some 
of  them  have  over  a  thousand  beds,  though  the 
average  is  about  three  or  four  hundred.  The  main 


96  THE  DOCTOR  IN  WAR 

difference  between  it  and  a  city  hospital  is  that  it 
is  built  of  wood  instead  of  brick  or  stone  and  that 
it  lies  alongside  of  a  railway  line.  Its  wards  consist 
of  long,  plain  but  comfortable  wooden  buildings, 
some  sixty  feet  long  by  twenty-odd  wide,  with  win- 
dows every  ten  feet  and  a  ventilator  in  the  roof,  called 
by  the  absurd  and  inadequate  name  of  ''huts."  They 
have  good  wooden  floors,  tarred,  weather- tight  roofs, 
windows,  with  a  ''hopper"  upper  sash  for  oblique 
ventilation,  and  stoves  so  that  they  can  be  kept  warm 
and  dry  as  toast  in  cold  or  stormy  weather. 

Their  only  administrative  drawback  is  that  nurses 
and  patients  have  to  go  out  of  doors  each  time  they 
pass  from  one  ward  to  another  or  from  the  ward  to  the 
operating-room.  But  this  is  now  being  overcome  by 
grouping  them  together  by  fours  in  the  shape  of  the 
letter  "H,"  with  the  operating-  and  dressing-rooms 
as  the  cross-bar  and  connected  by  roofed  passage- 
ways. 

So  comfortable  and  efficient  are  these  stations  and 
so  well  do  they  serve  their  purpose  that  they  raise 
the  question,  in  the  minds  of  all  who  have  served  in 
them,  whether  it  is  really  necessary  in  our  great  city 
hospitals  to  spend  the  enormous  sums,  rising  some- 
times to  as  much  as  five  thousand  dollars  per  bed,  on 
huge  and  majestic  monuments  of  stone  and  steel  and 
glass,  when  all  the  fundamental  essentials  for  the 
care  of  the  sick  and  the  wounded,  in  plain,  vernac- 


A  WOUNDED  MAN  CHEERED  BY  A  CHAPLAIN  AS  HE   IS  BROUGHT 
IN   ON  THE   LIGHT   RAILWAY,  WESTERN   FRONT 


WOUNDED  ON   THE   LIGHT   RAILWAY,  SALONICA   FRONT 


THE  HAPPY  WARRIOR  97 

ular  phrase,  the  ''guts"  of  a  hospital,  are  provided 
here  in  wood  and  tar  paper  for  about  one  hundred 
dollars  per  bed  ?  A  question  which  our  experience  with 
sanatoria  for  tuberculosis  has  also  suggested  to  us. 

Modern  war  is  no  longer  solely  destructive;  nearly 
half  its  energies  are  devoted  to  clothing  and  feeding 
and  healing,  and  the  central  and  vital  knot  of  its 
work  of  healing,  repairing,  and  making  over  again  the 
wreckage  from  the  firing-line  is  the  Casualty  Clearing- 
Station. 

Into  its  front  gate  pour,  converging  like  the  sticks 
of  a  fan,  the  lines  of  ambulances  bearing  the  wounded 
from  a  five-  to  fifteen-mile  sector  of  the  Front.  From 
its  back  door,  which  opens  directly  upon  a  line  or 
spur  of  railway,  its  clean  and  convalescing  ''gradu- 
ates," when  pronounced  fit  to  travel,  are  "cleared" 
directly  into  the  comfortable  berths  of  the  long 
hospital  trains,  which  roll  them  down  to,  and  dis- 
tribute them  among,  the  great  base  hospitals  near 
the  coast,  or  to  the  quays  alongside  the  waiting 
hospital  ships  for  "Blighty  "  direct. 

From  the  moment  that  a  man  falls  and  is  picked  up 
by  the  stretcher-bearers,  the  superb  scheme  of  the 
Royal  Army  Medical  Service  takes  complete  and  com- 
petent charge  of  him.  All  he  has  to  do  is  to  press  the 
button  by  getting  wounded  and  it  does  the  rest,  and 
does  it  astoundingly,  incredibly  well.  Our  American 
Medical  Service  in  France  is  planned  and  carried  out 


98  THE  DOCTOR  IN  WAR 

along  almost  exactly  the  same  lines,  though  as  one 
after  another  of  our  army  surgeons  who  has  seen  the 
superb  British  system  at  work  has  exclaimed  to  me : 
^'If  we  can  only  build  up  anything  like  it  in  five 
years!" 

The  first  stage  of  his  journey  toward  recovery  — 
for  of  every  hundred  men  not  killed  outright  or 
dying  before  the  bearers  can  bring  them  in,  ninety 
recover  —  ends  at  the  Regimental  Aid  Station,  or 
"Poste  de  Secours"  as  the  French  call  it,  in  the 
third-line  trench  or  close  behind  it.  Usually  he  is 
carried  by  bearers  all  the  way  to  this,  but  in  par- 
ticularly well-planned  trenches,  where  the  nature  of 
the  ground  and  the  slant  of  the  enemy's  fire  per- 
mit, he  goes  on  wheels  along  extra  wide  communicat- 
ing trenches,  paved  so  as  to  allow  ammunition  to  be 
wheeled  out  in  handcarts  and  to  bring  wounded 
back,  or  even  laid  with  small  trolley  lines  and  hand- 
cars for  this  double  service.  This  is  a  great  mercy,  for 
though  the  stretcher-bearers  are  gentleness  itself, 
there  is  an  inevitable  swing  and  joggle  about  this 
method  of  carriage  which  is  agony  for  the  grating 
ends  of  a  broken  bone. 

If  the  wounded  man  is  so  badly  hurt  or  bleeding  so 
profusely  as  to  make  it  risky  to  lift  him,  a  tourniquet 
is  put  on  if  possible,  and  a  runner  sent  back  for  the 
surgeon.  This  does  n't  take  long,  for,  although  ac- 
cording to  the  Regulations,  a  surgeon's  place  is  in  the 


THE  HAPPY  WARRIOR  99 

third-line  trench,  for  good  and  obvious  reasons, 
when  the  wounded  are  coming  in  quicldy,  so  that 
they  know  just  where  to  find  him  and  where  he  has 
his  table  and  orderlies  and  ether  and  instruments, 
etc.,  he  is  often  found,  in  the  beginning  of  an  at- 
tack, well  up  in  the  second  or  even  the  front-line 
trenches ;  where  he  has  no  official  business  whatever, 
only  it  gives  the  men  confidence  and  they  like  to 
feel  that  he  is  close  at  hand  and  in  easy  reach,  in 
case  of  —  accidents. 

In  an  earlier  day  the  surgeon  often  actually  ''went 
over  the  top  "  with  the  rest  of  the  line  in  a  charge, 
but  the  men  themselves  affectionately  protested 
against  this.  Supposing  something  happened  to  the 
doctor  —  a  dozen  men  might  bleed  to  death  before 
another  surgeon  could  be  brought  up  from  the 
Dressing-Stations  in  the  rear;  and  it  is  no  longer 
considered  good  form. 

In  hundreds  of  instances,  however,  when  "No 
Man's  Land  *'  begins  to  get  populated  by  groaning 
and  writhing  figures,  over  has  gone  the  surgeon,  in- 
struments, ether,  bandages,  and  all,  and  establishing 
a  Dressing-Station  at  the  bottom  of  a  shell-crater, 
where  the  wounded  at  least  are  fairly  safe  from  every- 
thing but  a  direct  hit  of  shell,  has  gone  about  his 
healing  business  under  a  perfect  hell  of  fire,  as  calmly 
as  if  he  were  in  his  white  enameled  sky-lighted  operat- 
ing-room at  home. 


100  THE  DOCTOR  IN  WAR 

I  saw  the  ribbon  of  one  Victoria  Cross  on  the  coat 
of  a  quiet  young  surgeon,  who  after  a  charge  had 
walked  out  with  his  instruments  into  the  middle  of 
the  Zone  of  Death,  and,  dropping  on  his  knees  be- 
side the  first  wounded  man,  had  calmly  worked  his 
way  down  the  whole  length  of  the  regimental  front  with- 
out a  shred  of  cover  or  protection,  taking  every  case 
as  he  went,  both  friend  and  foe,  until  the  field  was 
cleared  of  wounded. 

There  are,  however,  practical  drawbacks  to  the 
shell-hole  dressing-station,  in  addition  to  its  extreme 
immediate  riskiness.  On  account  of  the  —  to  put  it 
mildly  —  indiscriminateness  of  the  Hun  fire,  you  are 
extremely  likely  to  have  half  the  wounded  you  have 
so  carefully  operated  on  and  patched  up  torn  to  bits 
by  a  shell  or  wounded  afresh  by  rifle  or  machine-gua 
bullets,  while  they  are  being  carried  to  the  shelter  of 
the  front  trench.  On  the  whole,  Tommy^s  judgment 
is  sound.  "  Better  risk  a  few  stretcher-bearers,  fetch- 
ing 'em  in,  or  if  the  strafing  is  too  fierce,  wait  till  dark." 

But  the  post  of  Regimental  Surgeon  is  something 
of  a  man*s  job  and  the  real  place  of  honor  in  this  War 
of  Life-Saving.  That  it  is  filled  by  real  men  in  hun- 
dreds may  be  grimly  glimpsed  from  the  report  that 
over  four  hundred  surgeons  were  killed  or  wounded 
on  the  Somme  alone  in  191 6. 

The  Regimental  Aid  Post  where  our  wounded 
man  first  halts  —  we  ought  to  have  a  good  single- 


DRESSING   A   GUARDS  OFFICER    ON  A   FLANDERS  BATTLE-FIELD 


CANADIAN   RED   CROSS  MEN  ATTENDING  TO   WOUNDED   GERMANS 
AT   AN   ADVANCE   DRESSING-STATION 


THE  HAPPY  WARRIOR  loi 

word  name  for  him,  like  the  French,  who  say  simply 
"un  blesse,"  "a  wounded,"  plural  ** blesses,"  as  a 
dear  old  French  surgeon-general  used  to  translate  it 
for  me  "our  poor  woundeds"  —  is  usually  in  a  dug- 
out, or  in  a  vaulted  hut  made  of  heavy  iron  arches, 
set  side  by  side  and  covered  with  earth  and  turf, 
known  as  "an  elephant";  because  nothing  delights 
the  Boche  so  much  as  nosing  out  one  of  these  aid 
posts  full  of  wounded  and  shelling  it. 

Here  the  surgeon,  with  his  table  and  orderlies,  cuts 
open  the  clothing  and  makes  a  rapid  but  careful  ex- 
amination of  the  wounds,  ties  up  any  spouting  or 
badly  oozing  arteries,  puts  temporary  splints  upon 
any  broken  limbs,  and  dresses  and  binds  up  the 
wounds,  for  the  trip  to  the  Casualty  Clearing-Sta- 
tion. If  the  wound  is  at  all  serious  he  gives  a  "shot " 
of  tetanus  anti- toxin,  to  ward  off  lockjaw,  and  if  the 
pain  is  severe  an  injection  of  morphine.  In  the  be- 
ginning of  the  war  there  was  an  alarming  amount  of 
tetanus,  or  lockjaw,  with  many  deaths,  among  the 
wounded;  due  chiefly  to  the  curious  fact  that  the 
battles  were  being  fought  upon  some  of  the  richest 
and  most  intensively  cultivated  land  in  Europe.  The 
soil,  having  been  very  heavily  fertilized  with  stable 
manure,  was  simply  swarming  with  tetanus  bacilli, 
whose  natural  habitat  is  the  intestinal  canal  of  the 
horse,  and  these  were  blown  deep  into  the  wounds 
on  fragments  of  shell.   Thanks  to  the  tetanus  anti- 


102  THE  DOCTOR  IN  WAR' 

toxin,  however,  this  deadly  disease  was  quickly 
brought  down  to  the  vanishing  point  and  has  been 
kept  there  ever  since,  but  only  by  dint  of  constant 
vigilance  and  by  free  use  of  the  preventive  dose.  The 
only  drawback  to  its  use  is  that  it  consists  of  the 
serum  of  the  blood  of  immunized  horses,  and  this 
"foreign  serum  "  sensitizes  the  blood  in  a  curious  way. 
So  that  if  a  man  gets  wounded  a  second  time  —  and 
thousands  of  them  do  —  and  a  second  dose  of  the 
anti-toxin  is  given,  he  may  break  out  into  a  furious 
itching  eruption  all  over,  like  giant  hives  or  nettle- 
rash.  The  anti-toxin  itself  has  nothing  to  do  with 
this,  it  is  simply  the  horse-blood  in  which  it  is  car- 
ried. Just  as  some  people  are  naturally  sensitized  to 
strawberries,  or  cheese,  or  shell-fish,  so  that  they 
*' break  out ''  and  itch  whenever  they  eat  them,  so  the 
"blesse"  who  has  been  given  one  dose  of  horse's 
blood  is  sometimes  sensitized  against  it  in  future. 
The  rash  fortunately  is  entirely  harmless,  but  it  is 
very  disagreeable  during  the  few  days  it  lasts. 

At  the  Regimental  Aid  Post  the  live  express 
package  is  "tagged  "  and  labeled  for  his  long  journey. 
An  orderly  writes  down  upon  a  colored  card  a  few 
vital  details,  his  name,  regiment,  place  and  hour  of 
wound,  nature  of  projectile,  and  the  surgeon  adds 
nature  of  wound,  kind  of  dressing  applied,  or  opera- 
tion done,  and  whether  anti-toxin  or  morphine  has 
been  given.    Usually  to  be  quite  sure  a  colored  cross 


THE  HAPPY  WARRIOR  103 

is  marked  on  his  forehead  with  an  indelible  pencil 
when  the  anti- toxin  is  injected. 

This  card  is  slipped  into  a  large  envelope  of  tough, 
translucent,  waterproof  paper,  closed  at  the  upper 
end  by  a  string  running  through  two  eyelet-holes, 
which  is  looped  round  his  neck  or  tied  through  the 
buttonhole  of  his  coat.  Each  place  where  he  is  ex- 
amined or  handled  or  kept  slips  in  another  card  of 
data,  usually  of  a  special  color,  with  notes  on  his 
temperature,  sleep,  progress,  etc.  So  that  when  he 
finally  reaches  either  the  last  Base  Hospital  or  home, 
the  history  clerk  cuts  the  loop  and  takes  out  a  com- 
plete history  and  clinical  record  of  the  case  which  he 
can  copy  into  the  hospital  register. 

Where  the  roads  are  **  unsanitary  *'  our  neatly 
tied  up  and  labeled  living  packet  may  have  to  lie 
on  his  stretcher  in  the  Aid  Station  till  dark,  when  it 
is  safe  for  the  ambulance  to  come  up,  but  if  there  is 
a  good  road  he  may  be  taken  on  a  wheeled  stretcher, 
which  is  not  large  enough  to  draw  the  enemy's  fire, 
or,  if  a  railroad  track  runs  near  by,  on  a  hand  trolley 
along  that. 

In  regions  near  a  canal  a  big  new  barge  is  cleaned, 
painted,  and  fitted  up  as  a  spick-and-span  floating 
Hospital  or  rather  Dressing-Station  and  Ambulance 
combined,  and  the  wounded  carried  directly  to  that 
and  floated  smoothly  and  luxuriously  down  to  the 
Base  Hospital.    Nothing  is  overlooked  in  this  war. 


104  THE  DOCTOR  IN  WAR 

The  wounded 's  next  stage  will  end  at  the  Advance 
Dressing-Station,  which  used  to  be  in  a  vacant  build- 
ing, but  now  is  usually  in  a  cellar,  or  large  cavern  or 
gallery  excavated  underground.  One  that  I  visited 
was  in  the  extensive  cellars  under  the  prison  of  a  now 
world-famous  little  town  with  a  Cloth-Hall.  The 
wisdom  of  its  being  underground  was  sharply  demon- 
strated the  very  day  I  was  there,  for  twelve  bearers 
had  been  badly  wounded  by  a  shell,  in  the  courtyard 
above  it  that  morning. 

Some  of  these  Dressing-Stations  are  quite  exten- 
sive, with  caverns  and  galleries  that  will  accommo- 
date four  or  five  hundred  men  and  a  staff  to  corre- 
spond. One  feature  strikes  you  curiously  as  you  go 
down  into  their  mine-like  entrance  and  that  is  double 
barriers  across  the  passage  of  thick  blanket  curtains, 
about  twenty  feet  apart.  These  are  for  protection 
against  gas  and  form  a  sort  of  "air  lock"  so  that 
the  outer  curtain  barrier  can  be  raised  to  allow  the 
bearers  to  rush  in  with  their  burdens  and  dropped 
again  behind  them. 

Then  the  air  in  the  "lock  *'  is  sprayed  with  a  soda 
solution  to  neutralize  the  poison  gas,  and  when  it  is 
cleared  the  second  curtain  barrier  is  raised  and  the 
wounded  carried  in  safely  without  risk  of  letting  in 
any  fumes.  The  curtains  themselves  are  kept  rnoist- 
ened  with  a  soda  solution,  for,  by  the  mercy  of 
Heaven,  when   the  deadly  strangling   chlorine   gas 


THE  HAPPY  WARRIOR  105 

comes  in  contact  with  moist  soda,  it  is  promptly 
transformed  into  harmless  common  salt  or  chloride 
of  sodium.  This  is  roughly  the  principle  of  the  famous 
gas-masks. 

Some  of  these  great  cave-hospitals  have  apparatus 
for  chemically  purifying  the  air  of  fumes  and  pump- 
ing it  in  to  supply  their  occupants  all  through  the 
thickest  gas  clouds. 

The  main  danger  against  which  these  precautions 
are  taken  is  gas-shells,  shells  which  when  they  ex- 
plode belch  out  thick  clouds  of  poisonous  gas  instead 
of  shrapnel  bullets.  This  gas  is  heavier  than  air  and 
pours  down  any  mine  or  cave  openings  like  so  much 
water.  If  Fritz  can  only  spot,  through  his  airmen, 
the  opening  of  a  cave  hospital  and  spatter  it  with  gas- 
shells  he  's  happy  for  a  week.  The  idea  of  strangling 
the  wretched  wounded  in  their  cots  undergi'ound  ap- 
peals strongly  to  his  sense  of  humor. 

So  constant  is  this  gas  danger  that  in  the  French 
Dressing-Stations  and  Field  Hospitals,  every  occu- 
pied bed  is  obliged  to  keep  a  gas-mask  hanging  in  its 
case  on  the  wall  close  to  its  head,  day  and  night. 

In  the  underground  Dressing-Stations  the  patient 
is  given  a  quick,  skillful  looking-over,  to  see  if  his 
wound  is  bleeding  again,  or  his  dressings  have  shifted 
in  any  way,  and  if  he  has  bled  heavily  or  is  severely 
shocked,  he  may  be  given  stimulants  and  warming 
drinks  and  kept  for  the  night;  or  if  an  immediate 


io6  THE  DOCTOR  IN  WAR 

operation  is  urgently  demanded,  it  may  be  done 
here. 

Some  cases  stand  traveling  very  badly,  like 
wounds  of  the  brain  or  of  the  abdomen,  and  these 
may  be  kept  and  carefully  tended  here,  for  a  week 
or  more;  but  the  vast  majority  get  merely  a  swift 
looking-over  and  such  operating  as  is  immediately 
necessary,  and  as  soon  as  darkness  comes  or  the  roads 
are  free  from  shell  fire,  they  are  lifted  into  the  ambu- 
lance again  and  rolled  back  toward  the  Hospital. 

On  their  way  they  usually  pass  through  another 
way-station,  known  as  the  Field  Ambulance.  The 
word  ^'ambulance,"  in  military  parlance,  means 
three  distinct  and  different  things:  First,  the  whole 
service  and  means  of  handling  the  wounded  from  the 
trenches  back  to  the  Casualty  Clearing-Station.  An 
Ambulance  in  this  sense  may  consist  of  forty  or  fifty 
vehicles,  ten  or  fifteen  doctors,  and  one  hundred 
orderlies  and  stretcher-bearers.  Second,  a  Field  Hos- 
pital of  from  fifty  to  one  hundred  beds,  usually  in 
tents  between  the  Dressing-Station  and  the  CCS. 
Third,  the  real  ambulance  or  vehicle  itself.  A  motor, 
often  of  a  well-known,  affectionately  jeered  at,  in- 
expensive American  make,  fitted  with  a  ihigh  van- 
body,  with  bunk-like  folding  racks  for  stretchers  on 
each  wall,  enabling  it  to  carry  four  *4iers  "  or  eight 
"sitters"  ("couches'*  and  "a  pieds,"  as  the  French 
say) ;  incidentally  one  of  the  greatest  minor  boons  to 


THE  HAPPY  WARRIOR  107 

the  safe  collection  and  comfort  of  the  wounded  which 
Heaven  has  vouchsafed  in  this  war. 

Here  our  pilgrim  gets  another  swift,  searching  ex- 
pert "once  over"  to  see  that  nothing  is  going  wrong, 
and  within  a  score  or  two  of  minutes  more  he  is 
rolling  smoothly  down  the  well-paved  military  road, 
and  circling  up  to  the  receiving  door  of  the  Casualty 
Clearing-Station. 

Here  he  is  met  by  the  surgeon  on  duty,  with  his 
orderlies  and  nurses,  who,  with  the  quickness  born  of 
much  practice,  run  over  his  history  cards,  deftly  re- 
move his  clothing  and  undo  or  expose  the  dressings. 
From  the  appearance  of  these  together  with  the  his- 
tory, the  surgeon  promptly  decides  whether  any 
operation  is  likely  to  be  necessary  or  not.  If  not,  he  is 
borne  swiftly  off  to  the  cleaning-up  room  of  a  ward, 
where  the  mud  of  the  trenches  is  scraped  off  of  him, 
and  the  blood  washed  out  of  his  hair  and  finger-nails, 
and  his  whole  body  sponged  and  cleaned  and  alcohol- 
rubbed.  A  bowl  of  hot  soup  or  fragrant  tea  is  given 
him,  and  finally,  cleaned  and  combed  and  resplend- 
ent in  a  gayly  striped  new  suit  of  pajamas,  he  sinks 
with  a  sigh  into  the  first  clean  soft  bed  with  real 
sheets  on  it  he  has  been  in  for  months  and  enters 
upon  the  delightful  adventure  of  getting  well,  with 
the  chances  thirty  to  one  in  his  favor. 

If  the  wounded  requires  an  operation,  he  is  carried 
at  once  to  the  preparation-room  of  the  operating- 


io8  THE  DOCTOR  IN  WAR 

theater.  A  very  large  majority  do  require  an  opera- 
tion in  these  days  of  shell-fire  wounds  when  no  one 
knows  how  many  splinters  of  shell  may  be  buried  in 
the  flesh ;  when  every  corner  of  the  wound  is  packed 
with  germs  from  the  soil,  and  the  tissues  not  merely 
torn  and  cut,  but  parts  of  them  so  pulped  and  shat- 
tered that  they  must  be  cut  and  cleared  away  in  order 
to  allow  the  wound  to  come  together  and  heal 
properly.  In  this  preparation-room,  he  is  swiftly  un- 
dressed and  washed  and  made  as  nearly  aseptic  as 
possible,  the  anaesthetic  for  the  operation  being  given 
first,  if  the  wounds  are  extensive  and  painful.  Then 
the  surgeon  on  duty  carefully  probes  the  wound  with 
a  gloved  finger  or  sterilized  forceps  and  gauges  the 
extent  of  the  injury  and  whether  nerves,  great  blood 
vessels  or  joints  are  involved. 

If  the  case  is  an  "average  "  one  the  surgeon  pro- 
ceeds with  the  operation  himself  at  once,  but  if  it 
presents  special  features  of  difficulty  or  interest,  he 
turns  it  over  to  the  surgical  specialist  on  the  staff  in 
whose  province  it  belongs.  For  the  staff  of  a  Casualty 
Clearing-Station,  while  young  and  keen,  are  not 
merely  fully  qualified  surgeons  with  from  one  to  five 
years*  hospital  experience,  but  at  least  half  of  them 
have  been  specially  trained  in  the  surgery  of  some 
particular  region.  One,  for  instance,  will  have  had 
special  experience  in  surgery  of  the  brain  and  spinal 
cord ;  another,  of  the  abdomen ;  another,  of  the  nerves ; 


THE  HAPPY  WARRIOR  109 

and  another,  of  the  joints.  Many  of  the  older  ones 
had  established  reputations  in  their  chosen  field,  be- 
fore the  war;  others,  the  younger,  have  been  care- 
fully trained  on  the  dreadfully  abundant  material 
since  the  outbreak  in  the  great  Base  and  Home  Hos- 
pitals. They  are  a  splendid  body  of  men,  with  the 
fire  and  enthusiasm  and  progressiveness  of  youth, 
tempered  by  the  experience  and  caution  of  age,  and 
they  all  work  together  like  one  man  for  one  object 
—  the  best  interests  of  the  wounded  and  the  increase 
of  surgical  knowledge  and  skill. 

Each  has  his  group  of  trained  assistants  and  opera- 
tion nurses,  and  so  superbly  are  they  organized,  and 
so  splendid  their  "team-work,"  that  it  is  no  unusual 
thing  for  a  staff  of  ten  or  twelve,  working  triple 
shifts,  —  that  is,  six  hours  operating,  three  hours 
rest,  and  repeat  till  finished,  —  to  take  care  of  four 
hundred,  five  hundred,  even  seven  hundred  patients 
in  twenty-four  hours.  Indeed,  one  mammoth  field 
hospital  that  I  visited,  with  a  staff  of  sixteen  sur- 
geons and  their  squads,  had  actually  dealt  with  four- 
teen hundred  patients  in  the  preceding  thirty-six 
hours !  One  of  the  surgeons  told  me  that  he  had  been 
in  the  operating-room  from  two  o'clock  one  morning 
till  six  the  next  with  only  four  hours'  sleep,  but  he 
was  going  to  sleep  for  a  week  now,  to  catch  up. 

Lest  anything  should  possibly  be  overlooked  and 
the  patient  fail  to  get  the  utmost  benefit  of  all  the  sldll 


no  THE  DOCTOR  IN  WAR 

and  knowledge  in  possession  of  the  medical  profession, 
these  Casualty  Clearing-Stations  and  all  other  Mili- 
tary Hospitals  are  provided  with  a  staff  of  consul- 
tants. Men  whose  names  are  household  words  in  the 
medical  profession,  not  merely  of  England,  but  of 
America  and  all  over  Europe,  who  have  abandoned 
huge  and  princely  practices  and  for  the  mere  pittance 
of  an  Army  officer's  pay,  travel  incessantly,  up  and 
down  the  whole  zone  of  the  armies,  visiting  every 
place  where  wounded  are  cared  for,  from  the  smallest 
Advance  Dressing-Station  to  the  hugest  Base  Hos- 
pital, advising,  encouraging,  assisting;  placing  all 
their  skill  and  their  fame  and  their  experience  at  the 
service  of  the  injured. 

If  there  is  anything  puzzling  or  unusual,  or  spe- 
cially serious  and  grave,  or  a  delicate  question  as  to 
the  nature  of  the  operation  to  be  performed,  all  that 
is  necessary  is  to  send  a  telephone  message  on  to  the 
"D.D.M.S."  (Director  of  Medical  Service  of  the 
District),  and  one  of  these  consultants  will  arrive  at 
the  Hospital  next  morning,  or  within  a  few  hours,  if 
the  case  be  urgent. 

The  superb  hospital  trains  deserve  a  chapter  to 
themselves.  Arranged  like  Pullmans  with  permanent 
berths  along  both  sides  vestibuled  together  they  carry 
from  one  to  two  hundred  *'cot"  cases  and  twice  as 
many  "sitters."  They  have  complete  kitchens  and 
staffs,  dressing-rooms,  small  operating  room  for  emer- 


THE  HAPPY  WARRIOR  iii 

gencies,  full  staff  of  doctors  and  nurses  and  provi- 
sions and  supplies  for  three  days.  In  drives  ordinary- 
passenger  cars  are  hastily  transformed,  seats  turned 
into  bunks,  baggage  or  even  box  cars  into  kitchens 
and  dressing-rooms.  But  all  carry  the  wounded  in 
comfort  and  perfect  safety  and  the  newer  de  luxe 
hospital  in  trains  in  positive  luxury. 

To  describe  the  perfection  of  the  nursing  service 
and  general  management  of  the  Clearing-Stations 
and  Field  Hospitals  would  be  a  sheer  waste  of  words. 
Every  one  who  has  visited  a  ward  in  a  War  Hospital, 
or  who  has  had  letters  from  a  wounded  member  of  his 
family,  knows  all  about  them,  with  their  spotless 
linen,  their  bright-colored  blankets  and  mattings, 
their  flowers  and  their  pictures.  Ever3rv\rhere  woman 
has  been  permitted  to  go  in  this  war  she  has  made  a 
little  paradise  of  comfort  and  helpfulness. 

When  it  comes  to  the  nurses  themselves  —  trained 
or  volunteer,  Red  Cross  or  V.A.D.,  their  skill,  their 
unwearied  devotion,  their  courage  and  self-sacrifice, 
one  can  only  paraphrase  the  old  Hindoo  saying, 
"God  could  n't  be  everywhere,  so  he  made  nurses." 

In  fine,  the  net  result  is  that  every  wounded  man 
on  the  Western  Front,  from  the  private  to  the  general, 
receives  unfailingly  treatment  and  care  which  for 
effectiveness,  perfection  in  every  detail,  and  pitch 
of  professional  skill  a  millionaire  might  envy,  and 
than  which  not  all  his  wealth  could  purchase  any 


112  THE  DOCTOR  IN  WAR 

better.  It  is  really  difficult  to  imagine  anything 
finer. 

Its  results  in  cold,  passionless  figures  speak  for 
themselves.  Of  those  surviving  twenty-four  hours, 
ninety  per  cent  recover;  of  those  reaching  the  Clear- 
ing-Stations, ninety-five  per  cent  get  well ;  and  there 
are  many  Base  Hospitals  which  have  "graduated" 
tens  of  thousands  of  cases  with  less  than  one  per  cent 
of  deaths!   No  wonder  the  wounded  look  cheerful! 

Their  names  are  not  so  frequently  mentioned  in 
the  dispatches  as  those  of  the  commanders  of  the 
Line,  but  the  Nation  will  never  forget  its  debt  of 
gratitude  to  the  men  whose  skill  and  superb  ability 
and  devotion  have  organized  and  directed  this  mag- 
nificent service  of  life-saving;  —  Sir  Alfred  Keogh 
in  England,  and  Sir  Arthur  Sloggett  and  General 
McPherson  in  France,  with  their  devoted  staffs  and 
surgeons  of  the  Royal  Army  Medical  Corps,  and  in 
our  American  Army  General  Gorgas  in  Washington 
and  General  Ireland  in  France.  .< 


VI 

A  DAY  IN  A  FRENCH  FIELD  HOSPITAL 

THIS  is  a  war  of  initials  and  nicknames.  Its 
greatest  and  most  beloved  General  is  **Papa 
Joffre,"  its  most  terrible  explosive  ''T.N.T.";  its 
favorite  piece  of  artillery,  the  "Soixante-quinze**  or 
*'75"  millimetres  (bore  3  inches);  the  fine  fighting 
men  from  the  Colonies  rejoice  in  the  title  of '' Anzacs  " ; 
and  our  own  American  soldier  boys  have  been  christ- 
ened **Amex." 

The  Front  itself  fairly  bristles  with  initials,  and 
your  guide-posts  at  every  corner  are  white  boards 
bearing  bewildering  arrangements  of  large  black 
capital  letters,  some  of  which  it  would  require  the 
ingenuity  of  a  Sherlock  Holmes  to  interpret,  though 
to  the  initiated  they  are  as  plain  as  print. 

If  you  are  bent  on  errands  or  matters  medical  you 
should  keep  a  sharp  lookout  for  a  sign  with  an  "  M  '* 
on  it,  either  "D.M.S."  (Director  of  Medical  Service) 
or  *'S.S.M."  (Service  de  Sant6  Militaire),  according 
to  the  army  you  happen  to  be  in.  Only  don't  let 
another  rather  frequent  sign  with  an  "  M  "  in  it  mis- 
lead you,  for  "  A.P.M."  (Assistant  Provost  Marshal) 
or  ''Police  Militaire  *'  will  land  you  in  the  office  of 
the  Military  Policeman,  a  very  stern  and  dangerous 


114  THE  DOCTOR  IN  WAR 

person,  indeed,  with  an  insatiable  thirst  for  prying 
into  your  private  life  and  the  dates  and  vis6s  on  your 
passes. 

So  that  when  our  chauffeur  caught  sight,  through 
the  dust  of  a  crowded  and  teeming  roadway,  not 
many  miles  behind  a  rather  lively  section  of  the 
French  Front,  of  a  large  board  with  the  inscription 
in  huge  black  letters,  ''H.O.E.  No.  121,"  —  this  is  not 
the  real  number  or  the  censors  would  not  have  let  it 
pass,  —  he  knew  that  we  had  reached  our  destina- 
tion, and  swung  into  the  entrance  way  underneath  it. 

These  letters  meant  nothing,  however,  to  my  be- 
nighted eye,  and  after  puzzling  over  them  for  some 
minutes,  I  followed  my  usual  procedure  and  asked 
the  courteous  Surgeon  Inspector  of  the  Army,  who 
was  accompanying  me,  what  they  stood  for.  "Oh," 
he  said,  '* '  H.O.*  is  for  hospital  and  'E*  for  'evacua- 
tion,' and  we  call  it  'Ashooway.* '*  And  since  a 
Frenchman  actually  does  not  know  when  he  is  or  is 
not  pronouncing  an  "h,"  it  frequently  comes  out 
"Hashooway."  In  English  it  becomes  **C.C.S."  or 
Casualty  Clearing-Station,  and  in  our  Army  "Evacu- 
ation Hospital." 

Under  whatever  name  it  goes,  however,  it  is  a 
most  useful  and  important  institution  in  all  three  ar- 
mies, and,  curiously  enough,  is  quite  outgrowing  its 
rather  singular  name.  Beginning  as  a  small  canvas- 
covered  affair,  with  only  a  few  dozen  beds,  where  the 


A  DAY  IN  A  FIELD  HOSPITAL    115 

wounded  could  be  cared  for  overnight,  or  for  a  few 
days  until  they  could  be  "cleared  "  or  "evacuated'* 
into  the  hospital  trains  or  wagon  convoys  for  trans- 
portation to  the  base,  it  has  now  gfown  into  one  of  the 
most  important  hospital  centers  of  the  war.  This 
was  due  partly  to  the  comparative  fixity  of  the  Front 
which  gave  plenty  of  time  to  build  railroads  and 
bring  hospital  equipments  and  supplies  close  up  to 
the  firing-line;  partly  to  the  blessed  boon  of  the  motor 
ambulance,  which  can  carry  a  wounded  man  on  aver- 
age roads  ten  miles,  on  good  ones  thirty,  more  easily 
than  stretcher-bearers  could  one.  As  a  consequence, 
a  regular  line  of  these  houses  of  mercy  has  sprung  up 
parallel  with  and  from  seven  to  ten  miles  behind  the 
firing-line. 

The  tents  have  been  replaced  by  comfortable 
wooden  wards.  The  operating-rooms  are  as  per- 
fectly equipped  and  splendidly  managed  as  in  a  high- 
class  city  hospital.  An  X-Ray  Room,  a  Bacteriological 
Laboratory,  bathrooms  with  hot  and  cold  water, 
electric  lights,  have  been  added  and  the  two  or  three 
dozen  cots  have  expanded  to  three  hundred,  six  hun- 
dred, fifteen  hundred  beds,  with  a  full  staff  of  expert 
surgeons  and,  best  of  all,  of  trained  women  nurses. 

The  one  which  we  had  come  to  visit  was  an  unusu- 
ally large  one,  containing  nearly  two  thousand  beds, 
and  stretching  its  thirty-odd  long  wooden  buildings 
along  a  ridge  or  shelf  on  the  side  of  a  beautiful  val- 


ii6  THE  DOCTOR  IN  WAR 

ley  just  above  a  little  river.  Its  "streets  '*  converged 
toward,  or  ran  parallel  with,  the  double-tracked  rail- 
road siding  with  high  platforms  from  which  the 
wounded  could  be  lifted  or  wheeled  directly  into  the 
waiting  hospital  train. 

At  one  end  were  the  cook-houses  and  kitchens.  At 
the  other  the  Officers*  Mess  and  the  Nurses*  Quar- 
ters. On  the  lower  side,  toward  the  river,  were  the 
disinfection  and  laundry  and  waste-disposal  plants, 
while  big  double  water- tanks  —  one  for  the  chlorina- 
tion  and  the  other  for  the  storage  of  the  water-supply 
—  towered  up  in  the  center  of  the  camp. 

The  situation  was  a  charming  one:  on  one  side  of 
the  valley,  behind  the  camp,  the  ground  rose  quite 
abruptly  until  it  reached  a  high,  rounded  hill,  crowned 
with  a  quaint  old  stone- walled,  gray-roofed  village 
and  topped  by  a  great  rough-hewn,  thick-walled 
church  —  half  cathedral,  half  fortress  in  appear- 
ance, which  was  a  landmark  for  thirty  miles. 

In  front,  on  the  other  side  of  the  river,  the  ground 
rose  more  gradually  for  a  mile  or  two,  then  began 
to  climb  rapidly,  and  finally  terminated  in  the  blue 
wooded  crest,  clear-cut  along  the  horizon,  of  a  very 
famous  and  much  fought-over  Ridge,  the  Chemin 
des  Dames. 

We  climbed  next  day  up  to  the  fortress-like  church, 
and  found  that  nearly  a  third  of  its  massive  eight- 
foot  walls  had  actually  belonged  to  an  ancient  cathe- 


A  DAY  IN  A  FIELD  HOSPITAL    117 

dral  which  the  cure  proudly  assured  us  was  a  famous 
holy  place  before  Rheims  was  ever  thought  of.  In- 
deed, according  to  him,  while  the  early  French  kings 
used  to  hold  their  show  coronations  in  the  upstart 
parvenu  cathedral  at  Rheims  they  always  used  to 
come  up  here  afterwards  for  a  second  ceremony  to 
make  sure  that  the  crown  was  properly  blessed  on,  so 
that  it  would  stick. 

;  We  were  first  shown  a  general  plan  of  the  hospital 
by  the  surgeon  commanding,  and  then  taken  through 
it  from  the  beginning  —  the  point  where  the  field 
ambulances  swung  up  to  the  platform  and  delivered 
their  burdens. 

First  of  all,  the  wounded  man,  or  "blesse"  is  car- 
ried into  the  first  of  the  so-called  ^'Salles  de  Triage  '* 
or  sorting  wards.  Here  his  name  and  regimental 
number,  and  if  he  is  in  condition  to  give  it,  the 
address  of  his  family,  are  taken;  his  side  arms  and 
cartridge-belt  are  taken  off  and  stored  away,  and 
his  kit-bag  and  personal  belongings  and  any  money 
or  other  articles  of  value  are  tied  up  in  a  neat  canvas 
bag,  and  deposited  in  racks  until  he  needs  them  in 
the  wards  or  is  ready  to  be  sent  on  from  the  hospital. 
Then  a  hasty  look-over  from  the  surgeon  sends  him 
into  one  of  the  two  other  **Salles  de  Triage"  — 
that  of  the  "Petits  Blesses"  if  he  is  only  slightly 
wounded  and  that  of  the  "Grands  Blesses"  if  he  is 
more  severely  so. 


Ii8  THE  DOCTOR  IN  WAR 

In  the  "petits  bless6s*'  division,  there  is  a  dress- 
ing-room with  junior  surgeon  and  staff,  and  the 
dressings  already  applied  at  the  *'Poste  de  Secours" 
or  Field  Ambulances  are  examined  and  replaced 
if  necessary;  then  if  the  wounds  are  light,  the 
"bless6"  is  sent  into  the  huts  or  tents  which  form  a 
sort  of  rest-camp,  which  is  not  under  full  hospital 
discipline,  but  where  he  is  very  well  taken  care  of 
until,  after  a  week  or  ten  days,  he  is  fit  to  go  back 
again  to  the  firing-line.  To  the  same  place  are  sent 
the  men  who  have  suffered  slight  accidents  or  strains, 
or  whose  digestion  has  given  way,  or  who  are  out  of 
sorts  generally,  without  any  fever  or  serious  illness, 
but  who  would  probably  develop  something  more 
serious  if  they  were  not  given  a  little  rest  and  special 
care  and  feeding.  These  so-called  rest-camps  or 
*'eclopes  *'  huts  have  been  found  extremely  useful  in 
this  war,  as  a  means  of  relieving  and  quickly  build- 
ing up  again  men,  particularly  of  the  older  classes, 
who  seem  to  be  getting,  in  the  expressive  parlance  of 
the  street,  *' under  the  weather"  or  "off  their  feed'* 
under  the  strain  of  trench  life.  A  week  of  rest  and 
comfort,  with  hot  baths  and  massage  and  some  extra 
delicacies  in  the  way  of  food,  often  does  wonders  for 
them  and  sends  them  back  feeling  quite  fit  again. 

It  was  considered  a  rather  quiet  section  of  the 
Front  at  that  time  —  though  it  has  wakened  up  with 
vengeance  since  —  but  there  was  a  steady  trickle  of 


A  DAY  IN  A  FIELD  HOSPITAL     119 

wounded  men  into  the  hospital,  ranging  from  fifty 
to  one  hundred  cases  a  day.  Three  motor  ambulances 
had  just  rolled  up  with  their  load,  so  that  when  we 
entered  the  third  "Salle  de  Triage,"  we  found  eight 
or  ten  silent  figures  resting  on  their  stretchers,  wait- 
ing to  be  carried  into  the  cleaning-up  room  for  oper- 
ation. 

I  say  "silent "  advisedly,  for  one  of  the  most  un- 
expected things,  in  this  war  of  surprises,  is  the  almost 
utter  absence  of  any  sounds  of  pain  or  outcry  of  any 
description  from  the  wounded.  I  have  seen  wounded 
men  literally  in  tens  of  thousands  from  within  a  few 
minutes  of  the  time  they  were  hit,  through  the  various 
stages  of  dressings  and  operations,  right  back  to  the 
Base  Hospital,  and  almost  the  only  sound  that  I 
have  heard  out  of  their  lips  was  that  of  cheerful  and 
often  joking  conversation  with  their  stretcher-bear- 
ers, their  doctors,  or  their  fellow  "blesses." 

Walk  through  the  wards  of  a  Military  Hospital, 
whether  a  front-line  ambulance,  "Ashooway,"  or 
Base,  and  you  hear  no  more  cries  of  pain  than  you 
would,  say,  in  the  surgical  ward  of  an  ordinary  city 
hospital.  Of  course,  there  are  exceptions,  but  they 
are  scarcely  one  in  thirty. 

Men  with  a  badly  shattered  fracture,  particularly 
of  the  thigh,  men  with  severe  shell  wound  of  the 
abdomen,  have  a  pretty  uncomfortable  time  of  it  for 
the  first  few  days,  and  can't  help  groaning  or  even 


120  THE  DOCTOR  IN  WAR 

crying  out  in  the  night  at  times.  Sometimes,  too,  a 
man  who  has  been  badly  hit  or  lost  a  good  deal  of 
blood,  or  stunned  so  that  his  nerves  are  severely 
shaken,  will  whimper,  half  under  his  breath,  in  a 
curious  sort  of  way,  like  a  lost  child  waking  suddenly 
in  the  night,  and  unable  to  make  out  where  he  is  or 
what  has  happened  to  him.  But  this  usually  soon 
passes  off  when  they  have  been  made  warm  and  com- 
fortable, and  given  hot  soup  and  stimulants,  so  that 
their  jangled  nerves  are  brought  back  into  tune  again. 
Part  of  this  cheerful  quietness  is  due  to  sheer 
pluck  and  a  brave  determination  to  put  the  best 
face  on  the  matter  and  encourage  others.  But 
part  of  it  is  due  to  purely  physical  factors.  Most 
mercifully  the  one  redeeming  feature  about  the  ter- 
rible shell  wounds  of  this  war  is  that  they  are  not 
nearly  so  painful  as  a  wound  from  the  old-fashioned, 
slower-moving  projectiles.  They  strike  with  such 
lightning-like  speed  and  tremendous  force,  that  they 
seem  to  crush  and  shatter  and  stun  the  nerves  in 
their  path  into  numbness,  which  sometimes  lasts  for 
several  days.  Indeed,  this  is  no  mere  figure  of  speech, 
for  one  of  the  most  serious  difficulties  in  restoring 
movement  and  strength  to  badly  broken  or  shattered 
limbs,  after  the  wounds  are  healed,  is  the  distressing 
frequency  with  which  important  nerves  or  nerve- 
trunks  of  considerable  size  have  been  cut  or  torn 
across,  leaving  the  muscles  below  them  paralyzed.^ 


LADY  LORRY-DRIVERS 


A  CHEERFUL  WOUNDED  CANADIAN  OFFICER  BOARDING  A 
HOSPITAL  TRAIN 


A  DAY  IN  A  FIELD  HOSPITAL    121 

The  other  factor  is  that  the  greatest  pain  and  most 
prolonged  agony  of  wounds  is  due  to  inflammation 
with  suppuration  and  abscess  formation,  and  these 
for  the  most  part,  in  spite  of  the  soil  infections  car- 
ried in  on  fragments  of  shell,  modern  surgery  has 
been  able  to  prevent;  or,  at  least,  by  its  methods  of 
continuous  flushing  and  cleansing  and  keeping  open 
of  the  wounds,  has  avoided  any  blocking  up  with 
consequent  rise  of  pressure,  heat,  and  throbbing 
pain. 

Many  of  the  men,  in  fact,  express  surprise  that 
they  should  be  laid  up  so  completely  by  wounds 
which  hurt  them  so  little  except  when  dressed  or 
moved  in  some  way.  Often  when  quite  badly 
wounded,  they  will  declare  that  they  did  not  know 
they  were  hit  until  one  of  their  legs  suddenly  gave 
way  under  them,  or  their  rifle  dropped  out  of  their 
hands,  and  for  several  seconds  were  quite  puzzled 
to  know  what  had  happened  to  them. 

Surgeons,  on  the  other  hand,  assured  me  that  if 
they  could  secure  a  steady  and  abundant  supply  of 
laughing-gas,  or  nitrous-oxide,  such  as  is  used  in 
dental  operations,  they  would  be  able  to  perform  a 
great  many  operations  under  that  alone,  because  the 
tissues  about  the  wound  are  so  numbed  that  if  the 
patient's  brain,  so  to  speak,  can  be  numbed  and  put 
to  sleep  for  a  few  minutes,  the  operation  will  be 
practically  over  before  he  regains  consciousness.   But 


122  THE  DOCTOR  IN  WAR 

as  both  laughing-gas  and  the  oxygen  which  has  to 
be  given  with  it  can  be  carried  only  in  large  heavy 
iron  tanks  or  containers,  which  are  very  inconven- 
ient to  transport,  this  method  is  not  generally  prac- 
ticable in  the  front-line  operating-rooms. 

From  the  ''Salle"  of  the  "Grands  Bless6s,"  the 
wounded  man  is  carried  into  the  cleaning-up  room, 
which  does  not  sound  very  romantic,  but  is  one 
of  the  most  indispensable  portals  of  the  military 
temple  of  healing.  Here  his  soiled  and  blood-soaked 
clothes  are  removed,  the  mud  of  the  trenches  is 
scrapped  and  scrubbed  and  sluiced  off  him  with  warm 
water  and  alcohol,  he  is  thoroughly  insect-powdered, 
and  put  into  clean  bed  garments.  Then  the  skilled 
bearers  of  the  operating  squad  lift  him  up  gently  and 
carry  him  into  the  etherization  room,  where,  after 
a  few  pungent,  aromatic,  half-strangling  breaths, 
he  knows  no  more  until  he  wakes  to  find  himself  in 
a  clean,  soft,  comfortable  bed,  with  hot- water  bottles 
round  him,  a  vision  in  white  ready  to  meet  his  every 
want,  and  a  thirty  to  one  chance  of  rapid  recovery. 

Whichever  ward  of  the  "H.O.E."  or  "CCS."  he 
awakes  in,  it  will  be  much  the  same  —  long,  light, 
clean,  cozy,  with  a  row  of  cots  down  each  side  and 
tables,  usually  decorated  with  flowers,  down  the 
center.  The  only  difference  between  the  wards  is 
that  usually  each  one  has  its  distinctive  tint  of 
bright-colored  counterpanes,  or  white  counterpanes 


A  DAY  IN  A  FIELD  HOSPITAL    123 

with  a  bright-colored  blanket  folded  across  the  foot 
of  each. 

As  you  enter  the  door  of  the  "baraque*'  ward,  you 
notice,  especially  upon  your  first  dozen  or  so  visits, 
one  striking  characteristic  of  all  these  war  hospitals, 
and  that  is  the  astonishingly  healthy,  rosy,  bright- 
eyed  vigorous  look  of  the  patients.  They  were  liter- 
ally in  the  pink  of  condition  when  they  were  hit;  a 
few  hours',  or  at  most  a  couple  of  nights'  good  rest 
is  abundant  for  their  vigorous  constitutions  to  make 
good  whatever  amount  of  blood  they  have  lost. 
Their  wounds,  after  they  have  been  skillfully  oper- 
ated on  and  dressed,  pain  them  comparatively  little, 
and  except  for  being  wound  up  in  dressings  or  mum- 
mified by  splints,  they  look  as  if  there  was  nothing- 
whatever  to  prevent  their  getting  right  up  and  walk- 
ing out  of  the  ward,  and  they  are  as  ready  for  jokes 
or  hilarious  repartee  as  so  many  healthy,  happy 
school-boys. 

They  have  an  excellent  appetite,  a  keen  enjoy- 
ment of  a  smoke,  a  lively  interest  in  the  news  of  the 
day,  and  literally  devour  novels  and  other  light  lit- 
erature, by  the  dozen  and  hundred. 

My  surgeon  friends  tell  me  that  they  will  bring 
their  novels  with  them  into  the  dressing-room,  lay 
them  face  downward  on  the  nearest  table  while  their 
wound  is  being  dressed,  and  pick  them  up  and  plunge 
into  them  again  the  moment  that  the  last  bandage 


124  THE  DOCTOR  IN  WAR 

is  in  place  and  they  are  lifted  and  carried  back  to  the 
ward. 

So  quickly,  in  fact,  does  one  come  to  expect  this 
air  of  health  and  cheerfulness,  as  a  matter  of  course, 
that  one  is  positively  struck  by  the  exceptions.  In  one 
of  the  wards  of  this  very  hospital,  I  was  walking  down 
the  center  with  the  surgeon  and  head  nurse,  when  my 
eye  was  suddenly  caught  by  a  sallow,  languid,  wearied- 
looking  face,  against  a  white  pillow.  So  astonished 
was  I  that  I  instinctively  and  unconsciously  stopped 
and  the  question  leaped  involuntarily  to  my  lips, 
"Why,  what's  the  matter  with  that  man?  He  must 
be  sick!"  "Oh,"  said  the  surgeon,  "he's  just  back 
from  Salonica,  and  the  wound  has  waked  up  his 
malaria  again." 


VII 

THE  RISKS  OF  A  RED  CROSS  NURSE 

CLEAN  and  cozy  and  comfortable  as  were  the 
wards  of  this  great  French  Field  Hospital,  at 

M they  were  only  a  fair  sample  of  those  which 

are  to  be  found  all  along  behind  the  four  hundred-odd 
mile  battle-line  of  the  Western  Front,  wherever  it 
is  considered  safe  and  proper  to  have  women  nurses. 
There  was  a  little  attitude  of  conservatism,  of  re- 
serve, in  the  minds  of  the  French  Military  Authori- 
ties on  this  question  at  the  beginning  of  the  war:  a 
little  survival,  perhaps,  of  the  attitude  revealed  in 
the  half-alarmed,  half-exasperated,  most  ungallant 
old-bachelor  ejaculation,  attributed  to  Lord  Kitchener 
during  the  Boer  War,  **The  Lord  deliver  us  from  the 
plague  of  women."  Partly  a  feeling  that  it  was  against 
all  the  traditions  and  perhaps  not  quite  proper  for 
wounded  men  to  be  nursed  by  women  in  Field  Hos- 
pitals under  war  conditions,  and  the  demands  that 
these  involved.  Partly  a  fear  that  women  would  not 
be  satisfied  with  the  primitive  accommodations  and 
plain  diet  of  the  campaigner. 

Deeper  yet,  though  not  perhaps  so  freely  expressed 
from  reasons  of  politeness,  was  the  belief  that,  being 
the  weaker  and  more  timorous  sex,  they  would  be- 


126  THE  DOCTOR  IN  WAR 

come  unnerved  and  panicky  under  the  conditions  and 
threatenings  of  danger  which  are  inseparable  from 
hospitals  in  the  field. 

But  all  these  doubts  and  fears  have  been  grandly 
swept  away  and  women  have  shown  triumphantly 
in  this  war,  as  in  every  other  when  they  have  been 
given  the  opportunity,  that  their  place  is  wherever 
suffering  is;  that  if  there  be  any  place  which  is  not 
fit  for  a  woman  to  live  and  work  in,  let  her  in  and  she 
will  make  it  so. 

She  has  won  her  way  into  and  proved  her  priceless 
value  in  one  line  of  Field  Hospitals  after  another, 
wherever  wounded  men  are  kept  and  tended,  right 
up  to  the  Field  Ambulances  themselves,  and  the  pro- 
gressive surgeons  are  urging  her  admission  into  some 
of  the  more  stationary  even  of  these. 

You  can  tell  in  an  instant,  just  by  looking  in  at  the 
door  of  a  Field  Hospital  ward,  whether  there  are 
women  nurses  or  not.  Even  if  your  eyes  did  not  in- 
form you,  your  nose  would.  I  have  seen  a  good  many 
Hospitals  and  Ambulance  wards,  where  on  account 
of  danger  or  remoteness  or  some  other  reason,  the 
wounded  were  being  cared  for  only  by  men;  and 
while  they  were  well  looked  after,  their  wounds  well 
tended,  given  plenty  to  eat,  and  their  beds  kept  ship- 
shape in  a  good  ''farmhand  *'  sort  of  fashion,  yet  there 
was  not  anything  approaching  that  beautiful  finish 
of  neatness  and  tidiness,  and  what  was  more  signi- 


RISKS  OF  A  RED  CROSS  NURSE    127 

ficant  that  clean,  blissful,  comforted  expression  upon 
the  faces  of  the  patients  that  one  sees  in  wards  where 
women  nurses  rule. 

No  mere  man  will  ever  keep  floors  really  clean,  and 
beds  white-sheeted  and  tidy,  and  windows  hung  with 
white  curtains,  except  occasionally  under  severe  naval 
discipline  on  shipboard,  to  say  nothing  of  the  score 
of  slight  but  vital  trifles  which  go  to  make  up  all  the 
difference  between  a  bunk-house  and  a  cozy,  com- 
fortable, homelike  ward. 

Of  course,  it  is  possible  to  overdo  it  and  make  the 
men  uncomfortably  clean.  In  one  beautifully  kept 
ward,  some  of  the  Italian  wounded  privately  and 
most  apologetically  explained  to  a  sympathetic  visi- 
tor, that  while  the  lady  nurses  were  angels  and  they 
could  never  say  too  much  of  their  devotion  and  their 
kindness,  yet  they  did  think  they  were  wasting  much 
good  water  in  washing  and  bathing  them  so  care- 
fully every  day.  Lying  in  such  a  spotless  bed  in  such 
a  beautifully  clean  room,  how  could  they  grow  dirty 
after  they  had  been  once  well  washed  and  bathed 
in  the  beginning?  But  usually  they  fairly  revel  in 
all  the  attention  that  is  given  them,  although  they 
would  be  perfectly  contented  with  much  less  exalted 
and  exacting  standards. 

As  for  the  hardships  of  campaign  life,  the  nurses 
will  take  the  plain  board-walled  shack  assigned  to 
them  for  quarters,  and  with  little  more  than  pic 


128  THE  DOCTOR  IN  WAR! 

tures  from  the  illustrated  papers  on  the  walls  and 
flowers  from  the  neighboring  fields  and  gardens,  a 
few  strips  of  cheap  matting  on  the  floor  and  the  hun- 
dred and  one  little  feminine  things  and  belongings 
that  no  true  woman  can  be  separated  from,  and  which 
mysteriously  find  themselves  wherever  she  goes,  turn 
it  into  a  cheerful,  homelike,  attractive  bungalow. 

With  dainty  tea-service  and  the  ever-available 
jams  and  preserves  and  tins  of  biscuits,  with  all  the 
tribe  of  potted  and  canned  goods,  they  can  embroider 
and  work  wonders  with  the  plain  and  substantial 
mess  ration  from  the  cook-house,  and  transform  it 
into  a  dinner  with  courses. 

Our  party  was  invited  to  afternoon  tea  in  the 
nurses*  quarters  of  this  H.O.E.,  where  we  found  a 
group  of  charming,  white-uniformed,  cultured,  in- 
telligent women,  French,  English,  and  American, 
serving  tea  upon  plain  board  tables  surrounded  by 
camp  chairs,  in  a  room  whose  bare  board  walls  had 
been  transformed  into  a  cozy  and  tasteful  summer 
cottage.  And  the  tea,  with  thin  buttered  slices  of 
war  bread  and  biscuits  and  cakes  and  sandwiches 
from  the  inexhaustible  resources  of  the  brood  of  tins, 
was  as  excellent  and  varied  and  appetizing  as  if  it 
had  been  served  on  a  wicker  table  in  a  shady  English 
garden. 

As  for  the  steadiness  of  feminine  nerves  under 
trying  circumstances,  we  happened  to  find  an  excel- 


RISKS  OF  A  RED  CROSS  NURSE     129 

lent  illustration  in  that  very  Hospital.  We  had  n't 
gone  far  on  our  rounds  through  the  wards,  before 
my  ear  caught  a  curious,  rather  musical,  prolonged 
whistling  sound.  At  first  I  thought  it  was  something 
blowing  off  from  one  of  the  numerous  dynamo  trucks, 
which  were  stationed  here  and  there  through  the 
hospital,  to  supply  electric  light,  hot  water,  or  cur- 
rent for  the  X-Ray  Room.  But  the  third  or  fourth 
time  that  I  heard  it,  I  discovered  that  it  seemed  to 
be  passing  through  the  air,  directly  over  our  heads. 
Half  suspecting  the  truth,  I  asked  the  lady  superin- 
tendent, who  was  accompanying  us,  what  it  was. 
"Oh,"  she  said,  ** that's  just  shells;  they  often  do 
that.  There 's  a  rail-head  about  three  quarters  of  a 
mile  behind  us,  and  the  Germans  shell  it  regularly 
whenever  they  happen  to  think  that  there  is  any 
concentration  of  troops  taking  place  there."  "Well, 
but,"  I  suggested,  "some  of  the  shells  might  get 
tired  —  spent,  I  believe  is  the  proper  technical  term 
—  and  fall  short  of  the  rail-head,  somewhere  in  this 
neighborhood."  "Oh,  yes,"  she  said  again;  "they 
do,  but  not  very  often.  One  fell  right  in  the  middle 
of  the  camp,  a  few  days  ago;  smashed  through  the 
roof  of  a  small  *baraque,'  but  fortunately  there  was 
no  one  in  it  at  the  time,  and  it  did  not  explode.  A 
number  have  dropped  round  the  edges  of  the  Hospi- 
tal camp.  If  you  listen  a  few  minutes  you  will  prob- 
ably hear  one  of  them  beginning  to  clatter  instead 


130  THE  DOCTOR  IN  WAR 

of  whine,  which  means  that  it  is  getting  pretty  nearly 
spent." 

So  I  listened,  and  sure  enough,  before  very  long, 
there  came  a  rushing,  whizzing  sound,  which  sud- 
denly changed  to  a  duttery,  dattery,  dack,  right 
over  our  heads,  like  a  boy  drawing  a  stick  along  a 
picket  fence.  ''There,"  said  the  Sister,  *'is  a  spent 
one  now."  When  we  got  to  the  upper  end  of  the  Hos- 
pital grounds,  she  led  us  to  a  little  viewpoint  from 
which  we  could  look  over  toward  the  rail-head  and 
see  the  strange  birds  that  were  whistling  over  our 
heads  strike  and  turn,  with  a  dull,  sudden  roar,  into 
a  great  burst  of  thick  brown  smoke  and  showers  of 
dirt.  That  tenor  chorus,  with  the  bass  refrain,  kept 
up  at  five  or  ten  minutes*  intervals  steadily  all 
through  the  afternoon,  and  only  died  away  at  that 
peaceful  hour  when  almost  everything  stops,  even  on 
the  battle-front  —  a  couple  of  hours  before  sundown. 

"Well,"  I  said  to  the  Sister,  "I  suppose  you  will 
have  a  rest  now,  until  the  whistle  blows  for  it  to  be- 
gin in  the  morning?"  "Oh,  no,  the  aeroplane  bombs 
at  night  are  far  the  worst."  And  of  this,  also,  w^e 
were  fated  to  have  actual  demonstration.  We  still 
had  another  hospital  to  inspect,  just  on  the  edge  of 
the  village,  below  the  church,  and  the  staff  most  hos- 
pitably urged  us  to  stay  the  night.  But  our  inspec- 
tor had  an  important  consultation  engagement  that 
evening,  twenty  miles  away,  and  so  we  motored  over 


RISKS  OF  A  RED  CROSS  NURSE     131 

and  slept  there.  When  we  came  back  in  the  morning, 
we  found  everything  in  a  state  of  suppressed  excite- 
ment. Four  bombs  had  been  dropped  in  the  night 
by  a  cruising  aeroplane,  right  between  two  of  the 
"baraque"  wards.  One  of  them  fortunately  was 
empty  and  it  was  the  worst  hit,  torn  and  riddled  and 
shattered  in  every  direction  by  the  fragments  of 
shell;  but  in  the  other,  two  patients  were  killed  and 
five  or  six  wounded,  among  the  latter,  a  nurse.  What 
particularly  interested  us  personally  was  that  this 
empty  ward  which  had  been  so  badly  riddled  was 
probably  the  place  where  we  should  have  been  put  to 
sleep  if  we  had  accepted  the  invitation  and  spent  the 
night  there ! 

Later  I  learned  that  the  bombing  at  night  had 
become  so  constant  and  so  serious  that  the  hospital 
had  to  be  cleared  of  its  wounded  and  temporarily 
abandoned.  As  it  had  forty-odd  buildings  and  nearly 
two  thousand  beds,  there  could  have  been  no  pos- 
sible mistake  as  to  its  character. 


VIII 

:^ GAS-GANGRENE  AND  TETANUS. 

THE  goodness  or  badness  of  a  thing  depends 
entirely  upon  its  surroundings,  where  it  finds 
itself,  as  the  French  say.  We  have  heard  much  from 
time  immemorial  of  the  healthfulness  of  close  con- 
tact with  Mother  Earth,  of  getting  back  to  and  in 
close  touch  with  her  fertile  and  sustaining  surface, 
her  soft  brown  lap. 

From  its  abundance  comes  all  our  sustenance, 
from  labor  in  its  brown  furrows  comes  half  our  health ; 
nay,  we  are  officially  informed  that  out  of  its  dust  our 
own  bodily  frames  were  originally  made.  But  that 
was  a  very,  very  long  time  ago,  and  to-day  to  mix 
any  more  of  the  dust  of  the  earth  into  our  bodies, 
whether  into  our  lungs  or  into  our  blood,  is  anything 
but  a  health-giving  affair. 

It  is  all  very  well  for  us  to  get  right  down  and  delve 
into  the  soil,  but  when  the  soil  begins  to  delve  into 
us,  it  is  another  matter.  Dust  of  the  earth,  in  the 
lungs  to-day,  spells  tuberculosis;  dust  in  the  stomach 
means  typhoid ;  dust  in  the  blood,  gas-gangrene  and 
tetanus. 

Of  course,  these  troubles  do  not  spring  from  the 
actual  substance  of  the  earth  itself,  in  one  sense,  — 


GAS-GANGRENE  AND  TETANUS     133 

the  sand  or  the  clay  out  of  which  it  is  made.  But  in 
another  sense  they  spring  from  the  soil  itself;  that 
is,  from  elements  which  are  an  essential  part  of  the 
soil,  which  in  fact  make  the  surface  of  the  earth 
into  soil,  and  without  which  there  would  be  no  life 
whatever  possible  upon  the  face  of  the  earth,  only 
a  barren  stretch  of  desert  sand  and  sun-baked  clays 
—the  bacteria  of  the  soil. 

The  soil,  in  fact,  is  alive,  not  dead,  and  bac- 
teria are  the  life  of  it.  Broadly  speaking,  the  fertility 
of  the  soil  depends  upon  the  number  of  bacteria  in 
it,  and  all  our  laborious  and  elaborate  methods  of 
cultivation  both  age-old  and  modern,  ploughing  and 
harrowing,  disking  and  dynamiting,  draining  and  ir- 
rigating, are  simply  to  enable  more  billions  of  bac- 
teria to  flourish  in  a  given  soil. 

Consequently  the  richer  and  more  superbly  culti- 
vated the  soil  is,  the  more  literally  alive  and  swarming 
it  is  with  bacteria,  and  indeed  in  market-garden  soil, 
for  instance,  the  bodies  of  the  bacteria,  infinitesimally 
tiny  as  they  are,  form  in  the  mass  actually  as  much  as 
ten  per  cent  of  its  bulk.  Most  of  these  bacteria  of  the 
soil,  if  they  happen  to  get  into  the  blood  or  into  the 
body,  either  die  at  once  or  produce  only  putrefactive 
changes  in  the  food  in  our  intestines,  because  they 
cannot  "eat"  or  grow"  upon  living  tissues. 

Only  one,  the  typhoid  bacillus,  has  learned  the 
trick  of  living  in  the  intestines;  one  more,  the  germ 


134  THE  DOCTOR  IN  WAR 

of  tuberculosis,  the  trick  of  nesting  in  the  lungs;  and 
only  two,  the  tetanus  germ  and  the  gas-bacillus, 
that  of  living  under  certain  conditions  in  wounds. 

Against  the  tetanus  bacillus  we  have  an  effective 
weapon,  a  certain  shield  in  the  form  of  the  tetanus 
anti-toxin.  By  the  mercy  of  Heaven,  the  tetanus  germ 
is  extremely  slow  in  starting  to  grow  in  a  wound,  so 
that  if  a  dose  of  the  anti- toxin  is  injected  into  the 
blood,  within  one  or  even  two  days  after  the  wound, 
though  preferably  within  a  few  hours,  it  protects  the 
body  against  its  invasion. 

Against  the  gas-bacillus  we  had  no  such  direct 
remedy,  so  a  new  line  of  defense  has  had  to  be  worked 
out.  This  germ,  under  ordinary  circumstances  and 
conditions,  attracts  very  little  attention  from  sur- 
geons or  from  human  beings.  He  is  a  peaceful  and 
blameless  agriculturist  living  in  and  on  the  soil,  at- 
tacking and  breaking  up  the  decaying  animal  and 
vegetable  matters  contained  in  it,  and  preparing 
them  for  absorption  by  the  roots  of  the  plants,  while 
at  the  same  time  getting  his  own  living  **on  the  side.'* 

In  the  course  of  this  beneficent  process,  the  ba- 
cillus produces  a  considerable  amount  of  gas,  as 
indeed  is  a  quite  common  habit  of  many  of  the  ba- 
cilli, illustrated  by  the  frothing  and  bubbling  which 
takes  place  in  the  ordinary  processes  of  fermentation, 
in  canned  fruit,  wine,  beer,  bread-raising  by  yeast,  etc. 

This  gas  in  the  soil  is  perfectly  harmless,  indeed 


GAS-GANGRENE  AND  TETANUS     135 

probably  rather  beneficial  than  otherwise,  by  in- 
creasing its  porousness  and  assisting  the  growth  of 
other  bacteria.  But  when  it  gets  into  the  human  body 
and  begins  to  liberate  it  in  the  tissues,  then  some 
very  distressing  effects  are  produced,  and  it  is  this 
fact  which  has  given  to  it  its  name  —  now  all  too 
familiar. 

When  a  group  of  these  gas-producing  bacteria  in 
the  soil  are  blown  on  a  piece  of  shell  deep  into  the 
human  body  they  find  themselves  in  clover.  The 
fragments  of  the  tissues  which  have  been  torn  and 
crushed  and  mangled  out  of  all  vitality  by  the  shells 
furnish  dead  animal  matter  for  them  to  grow  upon. 
They  are  deeply  enough  buried  to  be  freed  from  the 
thing  they  hate  most  —  the  oxygen  of  the  air;  and 
the  warmth  of  the  body  ''forces"  them  like  a  hot- 
house. The  result  is  that  after  about  forty-eight 
hours,  the  edges  of  the  wound  begin  to  swell  up 
and  turn  outward  or  backward,  making  it  open. 
The  discharge  from  the  wound  almost  stops,  and 
its  cut  surface  takes  on  a  curious  half-jellified,  half- 
mummified  sort  of  look;  then  the  whole  wounded 
limb  begins  to  swell  up  and  distend  in  the  most  ex- 
traordinary fashion,  turning,  as  it  does  so,  first  an 
ashy  white  and  then  a  greenish  color. 

This  is  because  the  tissues  are  being  literally  blown 
out  with  the  gas,  and  on  pressing  the  finger  down  on 
this  balloon-like  swelling,  a  distinct  crackling  or  tiny 


136  THE  DOCTOR  IN  WAR 

bubbling  sensation  can  be  felt.  The  gas  and  the 
swelling  extend  on  up  over  the  surface  of  the  body, 
bloating  it,  and  distorting  its  shape;  the  patient  be- 
gins to  complain,  not  so  much  of  pain  as  of  a  sense 
of  great  restlessness  and  depression  and  dread  of  what 
is  coming  next.  His  face  is  white  and  pinched,  his 
lips  bluish,  his  eyes  widely  distended  and  ''all  pupil," 
his  temperature,  instead  of  rising,  goes  steadily  down, 
down,  and  unless  something  can  be  done  to  stop  the 
terrible  march  death  ends  the  scene  within  forty-eight 
hours,  sometimes  within  twenty-four  of  the  first  ap- 
pearance of  gas  in  the  tissues. 

Small  wonder  that  both  surgeons  and  wounded 
stood  aghast  at  such  a  swift  and  deadly  process  of 
destruction  when  it  first  began  to  show  its  horrid 
front  in  our  spotless  and  speckless  war  hospitals  on 
the  Western  Front  as  it  did  in  thousands  in  the  early 
days  of  the  war.  Our  last  experience  with  anything 
resembling  it  had  been  with  the  dreaded  hospital 
gangrene  of  our  American  Civil  War. 

This  was  probably  a  mixed  infection,  a  gas-bacillus 
combined  with  a  pus  germ.  Streptococcus  or  Staphy- 
lococcus, though  we  shall  never  know  with  certainty 
because  it  was  before  the  days  of  Lister  and  Pasteur, 
and  germs  had  then  not  been  "invented."  Its  prog- 
ress was  somewhat  slower,  but  it  was  furiously  con- 
tagious, so  that  it  would  run  through  whole  wards, 
and  every  case  coming  into  an  infected    hospital, 


GAS-GANGRENE  AND  TETANUS     137 

even  though  suffering  from  the  merest  scratch,  would 
catch  it  and  have  a  desperate  fight  for  his  hfe.  As 
nearly  half  of  those  attacked  by  it  died,  it  was  one 
of  the  most  terrific  scourges  known  to  the  history  of 
surgery;  and  when  its  infection  once  got  into  a  hos- 
pital, that  hospital  had  to  be  emptied  and  closed  and 
the  patients  turned  out  into  tents. 

This  present  gas-gangrene  never  became  a  tenth 
as  bad  as  that,  for  it  had  just  one  redeeming  feature, 
and  that  is  it  is  not  actively  contagious  or  inclined  to 
spread ;  which  was  probably  because  modern  surgical 
precautions  were  able  to  bar  out  the  pus-forming 
germs  and  prevent  them  from  forming  that  "wicked 
partnership"  with  the  gas-bacillus  which  gave  its 
infection  wings,  so  to  speak. 

As  we  have  only  just  recently  developed  an  anti- 
toxin, for  three  years  of  struggle  and  experiment 
we  were  driven  to  hunt  for  other  weapons.  The  first 
hold  which  we  got  on  the  germs  came  from  the  fact 
that  they  are  what  are  known  as  **anerobic";  that  is 
to  say,  can  live  without  air,  and  not  only  that,  but 
are  killed  by,  or  grow  very  slowly  in,  the  presence  of 
air  and  oxygen.  This  being  the  case  it  was  quite 
evident  that  our  modern  aseptic  method  of  closing  and 
sewing  up  all  wounds  tightly  at  the  earliest  possible 
moment,  was  exactly  in  the  wrong  direction,  and  in- 
deed was  giving  the  bacillus  the  very  thing  that  he 
most  wanted,  airlessness  and  warmth.   Consequently 


138  THE  DOCTOR  IN  WAR 

it  became  the  rule  to  leave  all  shell  wounds  of  any 
considerable  depth,  or  of  pocketed,  irregular  shape,  or 
with  mouths  much  smaller  than  their  deeper  parts, 
as  wide  open  as  possible  for  the  first  three  to  five  days. 
This  at  once  diminished  the  number  of  our  cases  of 
gas-gangrene. 

The  next  step  was  the  discovery  that,  as  the  bacil- 
lus could  not  eat,  or  live  upon  living  tissue,  if  we  could 
manage  to  clean  and  cut  away  and  scrape  out  of  the 
wound  the  crushed  and  shattered  fragments  of  flesh 
whose  vitality  was  destroyed,  we  should  deprive  him 
of  any  food  to  live  upon  or  material  to  grow  on. 

When  this  was  thoroughly  done,  within  four  or  five, 
or  in  circumstances  where  it  was  necessary,  within 
thirty-six,  hours  of  the  receiving  of  the  wound,  our 
cases  of  gas-gangrene  took  another  and  much  heavier 
drop.  In  fact,  these  two  methods  of  *' ventilation" 
and  thorough  cleaning  brought  them  down  to  scarcely 
one  tenth  of  their  former  prevalence. 

Finally,  it  was  found  that  while  the  gas-bacillus, 
when  looked  for  by  microscopic  methods,  would  be 
found  in  two  thirds  or  even  three  fourths  of  all  the 
wounds  of  a  given  hospital,  and  that  many  of  the 
cases  had  not  been  for  various  reasons  able  to  be 
given  thorough  cleaning-out  of  the  wounds,  yet  the 
vast  majority  of  them  all  would  escape  any  real  gas- 
infection.  And,  what  was  the  important  point,  most 
of  those  who  did  develop  even  a  moderate  degree  of 


GAS-GANGRENE  AND  TETANUS     139 

gas- gangrene  were  cases  in  which  some  other  cause 
of  depression  was  at  work  —  they  had  had  severe 
hemorrhages  and  lost  a  lot  of  blood,  or  they  had 
fallen  in  No  Man's  Land,  or  in  a  shell  crater  in  the 
middle  of  a  great  battle  and  had  to  lie  out  in  the  mud 
and  rain  or  snow  for  six,  eight,  twenty,  or  even  thirty- 
six  hours  before  they  could  be  brought  in  and  at- 
tended to;  or  they  had  been  ill  or  in  bad  condition 
from  some  cause  before  they  were  wounded. 

In  short,  all  conditions  which  tended  to  lower  the 
vitality  of  the  wounded  man,  or  which  lowered  the 
vitality  of  the  tissues  in  his  wound  by  lack  of  timely 
and  prompt  attention,  increased  the  probability  of 
a  gas-infection.  The  first  and  second  of  these  pre- 
ventive steps,  namely,  the  thorough  cleaning-out  of 
all  dead  or  dying  tissues  in  the  wound,  technically 
known  as  "debridement,"  are  steps  in  the  now  fa- 
mous and  magnificently  successful  Carrel  treatment, 
and  wherever  that  is  introduced  gas-gangrene  sinks 
almost  to  the  vanishing  point,  though  unfortunately 
not  quite.  -^ 

Furthermore,  as  the  Medical  Service  on  both  the 
French  and  English  Fronts  has  become  more  per- 
fectly organized,  and  particularly  as  spur  lines  of 
railroad  and  trolley  lines  have  been  used  for  the 
transportation  of  the  wounded,  these  distressing  de- 
lays have  become  much  less  common,  except  when  the 
system  is  swamped  by  tens  of  thousands  of  wounded 


I40  THE  DOCTOR  IN  WAR 

in  a  few  days  from  some  great  battle,  and  cases  of 
gas-gangrene  have  gone  down  in  like  proportion. 

Even  before  we  had  any  anti- toxin  defense  against 
gas-gangrene,  we  had  brought  it  down  to  a  really 
encouragingly  low  figure.  For  instance,  I  spent  three 
full  weeks  on  the  Western  Fronts,  in  the  early  spring 
of  1 91 7,  visiting  new  hospitals  every  day  and  seeing 
tens  of  thousands  of  wounded,  and  in  every  hospital 
that  I  entered  one  of  my  first  questions  was:  Have 
you  any  typical  cases  of  well-marked  gas-gangrene? 
Only  once  was  it  answered  in  the  affirmative,  and  that 
in  the  last  hospital  but  one  that  I  visited  and  when 
I  was  in  despair  of  ever  seeing  a  case. 

There  were  a  number  of  cases  in  which  there  was 
some  slight  puffing  and  glazing  of  the  wound,  but 
upon  promptly  applying  the  principle  of  "letting  in 
the  light"  —  or  rather  air — by  slitting  open  the 
tissues  freely  in  all  directions  around  the  wound,  and 
putting  in  Carrel  tubes  if  not  already  in  use,  nine 
tenths  of  them  would  clear  up  promptly  without  any 
further  trouble.  In  a  series  of  later  trips  to  the  French 
Front  I  found  bad  cases  of  this  distressing  condition 
almost  equally  rare. 

Within  the  last  few  months  Dr.  Flexner,  of  the 
Rockefeller  Institute,  has  perfected  an  anti-toxin 
against  gas-gangrene  which  is  giving  excellent  re- 
sults, and  which  has  given  the  finishing  touch  to  our 
victory  over  gas-gangrene. 


GAS-GANGRENE  AND  TETANUS    141 

Incidentally,  it  may  be  said  that  there  is  a  curious 
confusion,  quite  common  in  the  public  mind,  between 
gas-gangrene  and  poison  gas  on  the  Front.  Both 
are  among  the  blessings  of  war,  but  other  than  that 
have  not,  of  course,  the  slightest  connection.  One 
form  of  the  confusion  is  the  idea  that  gas-gangrene 
is  the  result  of  gas  from  the  bombardments  getting 
into  the  wounds!  But  vile  and  abominable  as  gas- 
clouds  and  gas-shells  are,  and  heavy  the  disgrace 
and  we  hope  punishment  of  the  German  brutes  who 
invented  them,  their  gas,  chlorine,  has  no  injurious 
effect  upon  wounds  even  if  it  happens  to  be  blown 
into  contact  with  them.  On  the  contrary,  though 
somewhat  irritating,  it  would  have  a  distinct  anti- 
septic effect. 

Operative  surgery  for  the  last  thirty  years  has  been 
a  singularly  open  and  above-board  game,  with  all 
the  cards  on  the  table,  and  clear,  definite  rules.  If 
you  played  according  to  the  rules,  you  won,  in  the 
sense  of  swift  healing,  ''union  by  first  intention," 
as  it  was  called,  —  no  fever,  no  pus.  If  you  lost  by 
so  much  as  a  single  drop  of  pus  or  a  degree  of  tem- 
perature, it  was  because  you  had  used  bad  judgment 
or  overlooked  something. 

The  tissues  of  a  healthy  body  contain  no  pus 
germs ;  the  skin  has  only  a  few  feeble  types  occasion- 
ally inhabiting  it;  hence,  if  the  patient's  skin  was  well 
washed  and  sterilized,  and  the  surgeons  and  nurses 


142  THE  DOCTOR  IN  WAR 

kept  their  hands  and  gloves  and  dressings  surgically 
clean  and  sterile,  there  would  be  no  germs  in  the 
wound  and  consequently  no  pus  and  no  fever. 

So  confident  and  so  conscientious  were  some  great 
operators  that  they  actually  had  printed  and  hung 
up  in  their  hospital  wards  cards  with  the  motto, 
*' Every  patient  whose  wound  suppurates  has  a  right 
to  demand  the  reason  of  his  surgeon.'* 

Feeling  sure  that  there  were  no  germs  anywhere 
in  the  wound,  and  that  therefore  there  would  be  no 
*' matter"  or  pus  to  provide  for,  draining  by  rubber 
tube  or  gauze  strips  was  unnecessary.  The  wound 
could  be  closed  at  once,  its  sides  brought  carefully 
together  and  stitched  almost  as  tight  and  smooth  as 
a  tailor  would  patch  a  rent  in  a  coat. 

In  most  operations  which  had  not  been  done  on 
account  of  some  inflammatory  or  infected  condition, 
the  deliberate  aim  was  to  leave  no  gap  or  cavity  any- 
where even  in  the  deepest  part  of  the  wounds,  but 
to  bring  both  walls  or  lips  of  it  firmly  together  from 
bottom  to  top.  And  surgeons  vied  with  each  other 
in  devising  ingenious  forms  and  combinations  of 
stitches  which  would  produce  "perfect  coaptation": 
usually  at  least  two  sets  and  sometimes  even  three  or 
four  of  stitches  —  a  deep  one,  of  silkworm  gut  or  even 
wire,  to  draw  the  deepest  parts  of  the  wounds  to- 
gether, one  or  two  intermediate  layers  of  stitches  to 
draw  together  the  muscles  and  the  fatty  and  connec- 


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GAS-GANGRENE  AND  TETANUS    143 

tive  tissues  under  the  skin;  finally,  a  row  of  very  fine 
catgut  or  silk  to  bring  the  skin  together  almost  as 
smoothly  and  accurately  as  a  glove-maker  would 
stitch  a  seam  in  a  glove  —  in  fact,  one  of  the  most 
popular  skin  stitches  is  known  as  the  "glove-maker 
stitch." 

Some  surgeons  would  deftly  put  in  this  last  row  of 
stitches  from  below,  catching  only  the  under  surface 
of  the  skin,  without  piercing  it  at  all,  so  that  when 
this  "underground"  zigzag  was  drawn  tight,  the  lips 
of  the  wound  came  smoothly  together  without  any 
sign  of  stitches.  And  as  all  the  other  rows  of  stitches 
were  buried  deep  in  the  wound,  there  was  nothing 
whatever  to  be  seen  but  a  thin  red  line  along  the  skin 
where  the  wound  had  been.  These  buried  stitches 
or  sutures  were  of  catgut  or  silkworm  gut,  because 
these  being  animal  tissues  would  be  melted  and  ab- 
sorbed by  the  fluids  of  the  body  in  the  course  of  a 
week  or  so. 

But  with  the  outbreak  of  this  war  all  this  finesse 
had  to  be  thrown  to  the  winds.  Just  imagine  the 
change,  the  humiliating  descent  from  this  scientific 
accuracy,  this  faultless  handiwork,  and  kidglove 
embroidery  finish,  to  the  clumsy,  wide-open,  free- 
drainage  methods,  which  were  the  only  ones  appli- 
cable or  possible  in  dealing  with  the  jagged  gashes 
and  caverns  and  craters,  torn  by  high  explosive 
shells.  *  Gone  were  our  cherished  dreams  of  sterile 


144  THE  DOCTOR  IN  WAR 

wounds,  of  perfect  closure,  of  hairline  skin  sutures 
and  narrow  scars.  We  were  thrown  right  back  to 
the  old  rule-of- thumb,  pre-antiseptic  motto,  "Cut 
through  everything  soft,  saw  through  everything 
hard,  and  tie  everything  that  bleeds.'* 

At  first  we  made  a  noble,  half-despairing  attempt 
to  preserve  our  beautiful  technique  and  perfect 
finish.  We  cleaned  out  the  ragged,  blackened,  gaping 
wounds  as  best  we  could,  we  tied  the  bleeding  ar- 
teries, we  trimmed  up  their  ragged  edges,  stitched 
them  together  in  as  neat  a  seam  as  possible,  and 
"trusted  in  an  all- wise  and  unscrupulous  Providence,*' 
as  a  surgeon  cynic  in  one  of  the  big  field  hospitals 
remarked.  :■ 

We  did  not  have  long  to  trust,  for  the  prompt  re- 
sult was  an  explosion  of  gas-gangrene  and  tetanus, 
such  as  we  had  n't  seen  for  sixty  years;  indeed,  we 
had  fondly  imagined  that  we  never  should  again. 

Of  course,  shell  wounds  in  this  war  were  nearly  five 
times  as  numerous  as  ever  before,  but  still  we  had 
had  quite  a  considerable  experience  in  shell  wounds 
in  the  Boer,  Spanish- American,  and  Russo-Japanese 
Wars,  and  never  anything  like  this  as  a  result. 

We  were  not  left  long  in  doubt  —  no  sooner  had  we 
scraped  up  a  little  of  the  soil  of  the  battle-field,  dis- 
solved it  in  water,  and  put  it  under  a  microscope  than 
we  found  it  swarming  with  tetanus  germs,  and  another 
germ  criminal,  known  by  the  musical  and  poetic  title 


GAS-GANGRENE  AND  TETANUS    145 

of  Bacillus  gasogenes  {perjringens) ,  also,  to  be  {Per- 
fectly exact,  Welchii,  in  honor  of  its  discoverer,  the 
famous  Dr.  Welch,  of  Johns  Hopkins  University. 

The  tetanus  bacillus  caused  the  lockjaw,  and  the 
other  germ,  with  a  name  like  a  Spanish  hidalgo, 
caused  the  gas-gangrene.   So  the  mystery  was  solved. 

Why  had  n't  we  got  similar  results  from  our  shell 
wounds  in  the  Boer  War  and  the  Russo-Japanese 
campaigns?  A  little  further  investigation  and  re- 
flection quickly  told  us.  The  Boer  War  had  been 
fought  chiefly  over  barren  naked  veldt  or  rocky  hills, 
with  scarce  a  trace  of  cultivation  about  them,  and 
the  Russo-Japanese  War  had  been  fought  over  a 
richly  cultivated  country,  but  one  in  which  little  or 
no  horse  manure  had  been  used  as  a  fertilizer,  for  the 
reason  that  there  were  extremely  few  horses.  The 
battles  of  the  Western  Front  were  on  the  most  in- 
tensively cultivated  and  heavily  fertilized  land  in  the 
world,  enriched  chiefly  by  stable  manure,  and  as  the 
normal  habitat  of  both  the  tetanus  bacillus  and  the 
gas-bacillus  is  the  intestines  of  the  horse,  the  soil  was 
simply  swarming  with  them  both. 

Once  we  had  seen  the  enemy  he  was  soon  ours. 
A  message  flashed  to  the  laboratories  on  both  sides 
of  the  Atlantic  set  them  turning  out  the  tetanus 
anti-toxin,  literally  by  the  gallon.  The  Laboratory 
of  the  Health  Department  of  New  York  City  alone, 
for  instance,  supplied  over  seventy-five   thousand 


146  THE  DOCTOR  IN  WAR 

dollars*  worth  of  anti-toxin  and  typhoid  vaccine  in 
one  year.  Every  severely  wounded  man  was  given 
a  preventive  injection,  and  lockjaw  swiftly  declined 
to  the  vanishing  point,  where  it  has  been  held  ever 
since. 


IX 

HEALING  THE  WOUNDS  OF  WAR,  OR  THE 
CARREL  TRIUMPH 

THE  trench  seems  to  have  put  its  stamp  on  the 
whole  of  this  war.  Even  the  wounds  inflicted 
in  it  are  almost  trench-like  in  their  depth,  their  com- 
plexity, with  traverses,  saps,  and  branches  reaching 
in  every  direction,  and  above  all  in  their  difficulty  of 
drainage.  At  first  sight  one*s  feeling  is  one  of  as- 
tonishment that  such  a  network  of  burrows,  such  a 
system  of  underground  works  could  have  been  con- 
structed in  the  human  frame. 

I  have  seen  a  surgeon  thrust  his  sterilized  gloved 
hand  in  under  the  shoulder  blade  behind,  and  bring 
it  out  under  the  arm-pit  in  front,  with  plenty  of  room 
to  move  his  arm  up  and  down;  and  yet,  the  lung 
having  marvelously  escaped  being  penetrated,  and 
the  nerves  and  arteries  not  torn  across,  the  man  made 
good  recovery,  with  a  fairly  useful  arm.  ^ 

In  another  "bless6,"  a  powerfully  built  "Chasseur 
k  pied,"  there  was  a  cavity  in  the  great  muscles  of 
the  lower  part  of  the  back  which  looked  as  though 
a  small-sized  shrapnel  shell  had  buried  itself  down 
to  the  backbone,  and  then  exploded.  Mercifully,  the 
spinal  cord  was  unhurt.  The  walls  of  the  huge  crater, 


148  THE  DOCTOR  IN  WAR 

into  which  you  could  have  packed  a  half-dozen 
oranges,  were  as  clean  as  a  fresh-caught  trout.  The 
man  was  making  rapid  progress  toward  recovery, 
though  it  would  leave  a  scar  about  the  size  of  a 
frying-pan. 

Another  young  Hercules,  a  "Diable  Bleu,"  who 
lay  waiting  his  turn  on  the  operating  table,  was 
pointed  out  to  me  by  the  surgeon  as  having  fourteen 
different  wounds  large  enough  to  count,  —  and  they 
don*t  count  little  ones  on  the  Front,  —  and  yet  his 
pulse  and  color  were  good,  he  stood  the  operation 
finely,  and  in  a  few  days  he  was  considered  out  of 
danger. 

What  men  kept  in  perfect  condition  can  stand  and 
what  surgery  can  do  are  two  of  the  marvels  of  this 
war.  The  problem  before  the  surgeon  was  a  compli- 
cated one,  like  the  wounds.  They  were  deep,  irregular, 
pocketed  wounds,  not  only  very  difficult  to  drain  and 
close  smoothly,  but  also  packed  with  bacteria  of  the 
soil,  carried  upon  the  fragments  of  the  shell.  These 
bacteria,  coming  from  the  depths  of  the  soil,  and  liv- 
ing on  decaying  vegetable  and  animal  matter,  found 
just  the  conditions  that  were  needed  for  their  growth, 
in  the  depths  of  the  shell-wound ;  that  is,  absence  of 
oxygen  or  air,  and  the  presence  of  dead  or  dying 
animal  matter  in  the  flesh  destroyed  and  shattered 
by  the  shell  fragments, 
r  In  the  earlier  days  of  the  war  before  the  problem 


THE  CARREL  TRIUMPH  149 

had  been  solved,  they  did  so  flourish  and  prodtice 
a  good  deal  of  gas-gangrene.  The  wounds  were  so 
irregular  and  many-pocketed,  the  dirt  containing 
the  bacteria  driven  so  deeply  into  the  flesh  itself, 
that  it  was  impossible  to  get  them  clean,  in  the  sense 
of  clear  of  bacteria,  by  any  process  of  washing  or 
scrubbing  however  vigorous,  and  the  consequence 
was  that  these  bacteria  were  constantly  dropping 
into  the  cavity  of  the  wound  for  days  or  weeks  after 
the  injury.  It  was  impossible  to  clear  them  out 
before  they  could  begin  to  grow  and  produce  their 
poison,  even  by  dressing  the  wounds  twenty  times 
a  day,  had  this  been  feasible. 

The  only  thing,  apparently,  to  be  done  was,  so  to 
speak,  to  attack  them  in  their  lair,  by  keeping  the 
wounds  constantly  flushed  with  some  fluid  capable 
of  destroying  the  growth  of  the  germ. 

Scores  of  surgeons  and  bacteriologists  were  work- 
ing on  this  problem,  but  it  was  first  perfectly  solved 
by  the  genius  of  a  brilliant  young  French  surgeon, 
Alexis  Carrel,  born  and  educated  in  France,  who  had 
lived  for  years  and  won  national  reputation  in  Amer- 
ica as  a  discoverer  and  research  worker  in  surgery. 

Carrel's  method  of  attack  against  these  wound 
bacteria  was  a  twofold  one:  first,  depriving  them  of 
the  food  on  which  they  could  live;  second,  poisoning 
them  as  fast  as  they  came  out  of  the  walls  of  the 
wound,  before  they  could  begin  multiplying  or  get 


150  THE  DOCTOR  IN  WAR 

a  first  foothold.  His  first  great  advance  was  his  di9- 
covery,  after  months  of  careful  observation  in  the 
hospital  and  experiments  in  the  laboratory,  that  these 
bacteria  could  not  live  upon  living  tissue,  and  that, 
therefore,  in  cleaning  the  wound  out  at  the  first  dress- 
ing or  operation,  it  was  not  necessary  to  get  rid  of  all 
the  bacteria,  but  only  the  dead  and  damaged  frag- 
ments and  surfaces  of  the  tissue  which  would  furnish 
food  for  them  to  live  upon. 

This  simplified  the  problem  considerably,  for  while 
it  was  impossible  to  get  rid  of  the  bacteria  buried  down 
in  the  flesh,  it  was  practical  to  clean  the  wound,  so 
as  to  get  rid  of  all  the  tissue  that  was  dead  or  likely 
to  die. 

Of  course,  it  is  not  always  possible  to  do  such  a 
cleaning  completely  in  deep  and  extensive  wounds, 
and,  for  instance,  as  a  surgeon  with  whom  I  talked 
put  it,  with  a  touch  of  high  dramatic  exaggeration, 
*'  If  I  were  to  trim  away  all  the  badly  damaged  tissue 
in  some  cases,  I  should  have  to  trim  away  half  my 
patient."  But  in  the  great  majority  of  the  cases  a 
very  searching  and  thorough  house-cleaning  of  the 
wound,  called  by  Carrel  ^'debridement,"  can  be  car- 
ried out  with  such  excellent  effect  that  one  of  the 
most  prominent  of  French  surgeons  assured  me  that 
a  thorough  ** debridement"  was  nearly  two  thirds 
of  the  battle  for  recovery,  and  was  almost  the  most 
important  part  of  the  Carrel  treatment. 


THE  CARREL  TRIUMPH  151 

But  the  motto  of  the  surgeon  must  be  ''thorough." 
No  matter  how  huge  or  gaping  the  wound,  or  how 
broad  the  scar  appears  likely  to  be,  so  far  from  sav- 
ing every  scrap  and  vestige  of  skin  that  is  possible, 
so  as  to  close  it  over  the  wound,  the  surgeon  delib- 
erately goes  round  the  whole  edge  of  it  with  his 
scissors  or  scalpel,  and  cuts  off  a  strip  one  third  or 
one  fourth  of  an  inch  wide,  because  experience  shows 
that,  although  it  even  looks  healthy,  it  has  been  so 
badly  damaged  by  the  slash  of  the  shell  that  it  is 
certain  to  break  down  and  become  a  source  of  infec- 
tion to  the  wound.  « 
i  Then  the  wound  is  explored  by  sterilized  fingers 
and  drawn  open  as  widely  as  is  safe  and  feasible, 
to  get  a  clear  sight  of  its  sides  and  bottom,  and  all 
particles  of  torn,  crushed,  or  badly  damaged  flesh,  or 
fragments  cut  off  from  their  blood  supply,  are  cut  and 
scraped  away.  As  a  final  touch  a  pad  of  gauze  is 
drawn  over  the  end  of  some  blunt  instrument,  and 
the  whole  inner  surface  of  the  wound  scrubbed  and 
scraped  with  it. 

In  wounds  that  go  right  through  from  one  side  of 
the  limb  to  the  other,  I  have  seen  a  good-sized  strip 
of  gauze  pushed  through,  and  then  the  surgeon  takes 
hold  of  the  two  ends,  one  in  each  hand,  and  saws 
backwards  and  forwards  through  the  wound,  so  as 
to  clean  out  thoroughly  every  scrap  of  badly  dam- 
aged tissue. 


152  THE  DOCTOR  IN  WAR 

This  thorough  scrubbing-out  and  "laundrying" 
of  the  wound  takes  time  and  trouble  and  looks  at 
first  sight  rather  drastic  and  heroic  for  the  patient, 
but  he  is,  of  course,  under  ether,  and  feels  nothing, 
and  the  rapidity  with  which  wounds  will  begin  to 
heal  after  a  thorough  cleaning  and  ''debridement'* 
is  something  most  gratifying. 

So  striking  and  unmistakable  are  the  benefits 
of  this  thorough  "debridement"  that  practically  all 
surgeons,  and  even  advocates  of  other  methods  of 
treating  wounds  in  war,  are  in  favor  of  it.  In  fact, 
some  are  so  delighted  with  it  that  they  claim  to 
have  invented  it  themselves,  or  attempt  to  deny 
that  it  is  an  essential  or  original  part  of  the  Carrel 
treatment.  But  the  documentary  evidence  is  fatally 
against  them. 

The  second  great  step  is  that  of  the  continual  ir- 
rigation of  the  wounds  with  an  antiseptic  fluid  strong 
enough  to  kill  the  germs;  but  not  irritating  or  dan- 
gerous to  the  tissues  of  the  body  itself.  This  last  re- 
quirement is  by  no  means  as  simple  as  it  sounds,  for 
ever  since  the  very  first  discovery  of  antiseptics  by 
Lister,  the  medical  profession  had  been  driven  more 
and  more  strongly  to  the  conclusion  that  almost  all 
antiseptics  capable  of  destroying  germs  were  even 
more  capable  of  damaging  the  tissues  of  the  body. 
To  put  it  very  briefly,  we  were  more  easily  poisoned 
by  them  than  our  germ  visitors  were. 


THE  CARREL  TRIUMPH  153 

So  far  had  this  conviction  gone  that  the  vast  ma- 
jority of  surgeons  objected  to  the  very  name  "anti- 
septics/* which  means  Hterally,  ''against  infection," 
poisoning  the  germs  after  they  had  got  into  the  wound. 
They  insisted  upon  a  new  term,  invented  after  Lister, 
"asepsis,"  which  means  "without  infection,"  never 
allowing  any  germs  to  enter  the  wound  from  the 
patient's  body,  the  surgeon's  hands  or  instruments. 

The  majority  of  our  surgical  operations  within  the 
last  twenty  years  have  been  carried  out  on  this 
aseptic  plan,  using  no  germicides  on  the  instruments 
or  surgeon's  hands,  and  nothing  at  all  in  the  wound 
except  sterilized  water  or  a  little  alcohol.  So  that  it 
was  entirely  against  our  modern,  and  already  tra- 
ditional, practice  and  ideas  to  attempt  to  use  anti- 
septics for  the  purpose  of  killing  the  germs  in  wounds. 
A  hundred  eager  objections  were  made  to  prove  at 
once  that  any  antiseptic  fluid  was  necessarily  a  poison 
to  cell  life,  and  must  be  far  more  dangerous  to  the 
cells  of  the  patient's  body  than  to  the  germs.  This 
accounted,  in  considerable  degree,  for  the  tremen- 
dous prejudice  and  opposition  on  the  part  of  many 
doctors  to  the  Carrel  treatment  in  the  beginning, 
a  prejudice  that  was  scarcely  creditable  to  the  open- 
mindedness  of  the  medical  profession. 

The  Dakin-Carrel  antiseptic  fluid  might  and  even 
should  do  more  damage  to  the  patient's  body  than  it 
did  to  the  cells  themselves,  but  there  was  absolutely  no 


154  THE  DOCTOR  IN  WAR 

denying  or  getting  away  from  the  fact  that  a  patient 
treated  with  it  got  well  in  less  than  half  the  time 
than  under  any  other,  and  even  though  a  few  cells 
be  destroyed,  the  millions  left  seemed  to  be  invigo- 
rated by  the  process.  The  Carrel  treatment,  even 
with  its  innumerable  modifications,  has  done  more  to 
save  life,  save  limbs  from  amputation,  to  diminish 
suffering  and  hasten  recovery  than  any  other  surgical 
procedure  of  the  war. 

One  of  the  most  striking  features  of  this  war  is  the 
way  in  which  strange  and  unexpected  things  have 
suddenly  become  enormously  in  demand,  expensive 
and  difficult  to  get  in  proportion.  If,  for  instance, 
twenty  years  ago  any  one  had  mentioned  rubber  or 
cotton  as  among  the  most  vital  necessities  of  war,  he 
would  have  been  laughed  at.  Now  one  of  the  sternest 
practical  difficulties  which  concerns  the  hospital  is 
how  to  rescue  enough  rubber  for  its  purposes  from 
the  maw  of  the  ever-devouring  motor,  and  cotton  for 
its  dressings  from  the  seething  vats,  in  which  the  soft 
innocent  stuff  is  turned  into  fierce  and  deadly  explo- 
sives of  the  gun-cotton  and  nitro  families. 

In  the  case  of  rubber,  the  doctor  has  the  slight 
consolation  of  knowing  that  part  of  this  keen  com- 
petition is  between  two  humanities:  the  rubber  tires 
of  the  blessed  and  unspeakably  useful  motor  ambu- 
lance, as  against  his  gloves  and  irrigation  tubes.  It 


THE  CARREL  TRIUMPH  155 

would  scarcely  be  too  much  to  say  that  these  two 
uses  of  this  curious  vegetable  gum  have  done  more 
to  lessen  the  sufferings  of  the  wounded  than  any 
other  two  non-human  agencies  in  this  war.  The  old 
proverb  should  be  revised  to  read,  "There's  nothing 
like  rubber." 

One  of  the  greatest  practical  difficulties  which  the 
spread  of  the  Carrel  treatment  had  to  fight,  next  prob- 
ably after  the  native  inertia  of  a  certain  type  of 
surgical  mind,  was  the  scarcity  and  expensiveness  of 
rubber.  The  second  part  of  the  Carrel  method,  which 
comes  after  the  "  debridement,*'  requires  rubber  tub- 
ing literally  by  the  yard  for  every  patient. 

It  was  painfully  easy  for  those  who  on  various 
grounds  were  not  willing  to  adopt  the  treatment  to 
cry  out,  "Oh,  we  can't  possibly  secure  all  that  quan- 
tity of  rubber  tubing,  or  stand  the  expense  if  we  could 
get  it."  But  as  the  total  cost  of  an  irrigation  equip- 
ment, averaging  five  yards  of  tubing,  flasks,  nozzles, 
clips,  and  all  included,  is  a  little  under  three  dollars 
and  it  lasts  a  month,  that  argument  does  not  survive 
much  investigation,  considering  that  it  shortens  the 
time  of  healing,  on  an  average  one  half,  and  in  some 
cases  more,  saves  the  patient's  strength  by  diminish- 
ing suffering,  and  markedly  lessens  the  necessity  of 
amputations.  No  good  business  man  would  ever 
hesitate  over  the  question  of  investing  such  a  sum. 

For  instance,  one  of  the  best-known  American 


156  THE  DOCTOR  IN  WAR 

surgeons  in  France,  Dr.  Blake,  has  the  proud  record 
of  treating  a  thousand  successive  cases  of  serious 
wounds  under  a  modified  Carrel  method,  with  only 
four  amputations  ;  and  the  position  of  his  hospital  was 
such  that  only  grave  cases  —  mostly  bad  fractures, 
and  fully  one  third  of  them  raising  serious  question 
of  the  need  of  amputation  —  were  sent  to  it. 

The  equipment  for  irrigating  every  nook  and 
corner  of  the  wound  is  the  most  ingenious  part  of 
the  Carrel  treatment,  and  from  the  fact  that  it  is 
also  the  most  visible,  the  one  that  is  constantly  to 
be  seen  in  operations  at  all  hours,  by  all  visitors 
to  the  ward  during  the  whole  weeks-long  course  of 
healing,  it  has  come  to  be  looked  upon  as  being  the 
treatment  itself. 

In  one  sense  it  is  extremely  simple,  merely  a  pear- 
shaped  glass  flask,  known  as  an  **  ampoule,"  suspended 
from  an  upright  rod  fastened  to  the  head  of  the  bed, 
with  a  long  rubber  tube  leading  from  its  lower  open- 
ing down  to  the  wound,  and  there  breaking  up  into 
a  large  number  of  smaller  tubes.  The  rim  of  the 
mouth  or  upper  opening  of  the  ampoule  is  flared  out, 
so  that  it  can  be  easily  held  by  a  clip  or  a  cord,  and 
it  is  raised  about  three  or  four  feet  above  the  level 
of  the  mattress  to  give  the  pressure  that  has  been 
found  necessary  properly  to  flush  the  wound. 

At  first  sight  it  might  be  thought  that  a  single 
tube  inserted  into  the  deepest  part  of  the  wound 


THE  CARREL  TRIUMPH  157 

should  be  sufficient  to  flush  it;  but  this  was  very  soon 
found  to  be  insufficient.  Water  has  a  most  fiendish 
and  ingenious  way  of  hunting  and  finding  promptly 
the  shortest  way  out  of  a  particular  pocket,  and  then 
flowing  slowly  and  blissfully  along  that  course,  leav- 
ing almost  untouched  all  the  rest  of  the  area  that  it 
is  supposed  to  be  irrigating. 

This  was  first  met  by  tying  up  the  tube  at  the  bot- 
tom of  the  wound  and  punching  from  ten  to  twenty 
holes  in  its  side,  so  that  the  water  would  start  back 
from  a  dozen  points  instead  of  one.  But  even  this 
was  not  sufficient,  so  a  smaller  blind  tube  with  side 
perforations  was  passed  into  the  bottom  of  every 
one  of  the  pockets  and  corners  of  the  wound,  and 
this  method  was  found  to  meet  the  situation  and  to 
attack  and  overcome  the  germs  in  their  own  dens. 
So  that  if  you  look  closely  at  the  dressings  of  a 
beautifully  clean  and  comfortable  "bless6"  under  the 
Carrel  treatment,  you  will  find  that  the  large  tube 
leading  down  from  the  ampoule  to  the  wound  ends 
just  above  the  dressings  in  a  little  glass  distributor, 
or  forked  tube,  breaking  up  into  as  many  branches 
as  there  are  smaller  tubes  required  to  reach  every 
pocket  of  the  wound;  for  two  pockets  there  will  be 
a  simple  "  Y,"  for  three,  four,  or  five,  more,  a  curious 
little  multiplier  of  the  shape  of  a  comb  with  hollow 
back  and  teeth. 

A  very  large  and  deeply  pocketed  wound  may  have 


158  THE  DOCTOR  IN  WAR 

as  many  as  ten  or  even  twelve  tubes.  Naturally  the 
placing  of  these  numerous  tubes  judiciously  and  care- 
fully, so  as  to  keep  every  corner  of  the  wound  flushed, 
is  a  question  of  skill  and  careful  irrigation  on  the 
part  of  the  surgeon. 

Now  comes  the  question  of  the  flow  of  the  fluid. 
At  first  sight  it  would  appear  that  a  gentle,  continu- 
ous irrigation  would  be  decidedly  the  best  method, 
secured  by  a  very  slow,  continuous  flow  all  day  and 
all  night.  Accordingly,  a  very  ingenious  drop  by 
drop  apparatus  was  introduced  into  the  big  tube, 
and  a  gentle,  soaking,  continuous  flow  adopted.  This 
worked  admirably  and  is  still  Dr.  Carrel's  personal 
preference  for  the  treatment  of  surgical  cases. 

Other  surgeons,  on  the  other  hand,  who  enthusi- 
astically adopted  the  Carrel  treatment,  declare  that 
in  their  experience  this  method  has  the  disadvantage 
that  as  the  pressure  under  which  the  water  flows  is 
decidedly  low,  these  little  openings  at  the  side  of 
the  tubes  —  which,  of  course,  are  very  small,  hardly 
larger  than  a  good-sized  darning-needle  —  are  apt 
to  become  clogged  up  by  scraps  of  lint,  matter  or 
pus,  and  then  the  fluid  begins  to  short-circuit  itself 
out  of  the  wound  by  another  channel. 

Another  objection,  which  is  rather  a  serious  one 
practically,  is  that  the  business  of  the  water  being 
to  find  its  way  out  of  the  wound  as  continuously 
as  it  is  poured  in,  first  saturates  the  dressings  and 


THE  CARREL  TRIUMPH  159 

then  overflows  from  these  out  over  the  bedding  and 
clothing  of  the  patient,  and  finally,  if  not  most  in- 
geniously headed  off  by  rubber  sheetings,  into  the 
mattress  itself. 

The  method  which  they  prefer  is  the  alternate 
one,  also  discovered  by  Carrel,  of  short  flushings  at 
regular  intervals.  A  spring  clip  is  put  on  the  long 
tube  and  the  nurse  releases  this  every  two  hours  by 
the  pressure  of  her  fingers,  and  allows  the  water  to 
flow  for  a  period  depending  on  the  size  of  the  wound, 
on  an  average  three  minutes.  This  gives  sufficient 
force  to  drive  any  clots  or  obstructions  out  of  the 
little  holes  in  the  tube  and  to  force  water  into  every 
comer,  like  a  broom;  and  also,  from  the  nurse's  and 
hospital  management  point  of  view,  it  enables  them 
to  watch  the  result  of  the  flow  and  to  check  it  as  soon 
as  the  flooding  appears  on  the  surface  of  the  wound, 
thus  avoiding  a  good  deal  of  troublesome  overflowing 
and  leaking  which  is  quite  uncomfortable  for  the 
patient.  Carrel  himself,  however,  holds  that  the 
very  best  ideal  results  can  be  obtained  by  the  con- 
tinuous flow. 

This  is  the  standard  or  ^*fuH"  form  of  the  treat- 
ment, but  there  is  another  modification  of  it  which 
may  be  used,  in  first-line  Field  Hospitals,  for  in- 
stance, or  under  other  circumstances  which  render 
it  difficult  to  secure  or  erect  the  flush  tanks  or  am- 
poules ;  that  is,  putting  the  numerous  little  tubes  and 


i6o  THE  DOCTOR  IN  WAR 

distributors  into  the  wound  as  usual  and  then  flush- 
ing out  at  regular  intervals  ^by  the  use  of  a  glass 
syringe.' 

CarreFs  collaborator,  Dakin,  has  devised  a  special 
glass  syringe  of  very  simple  shape,  that  can  be 
easily  sterilized,  and  one  is  provided  for  each  patient, 
so  as  to  avoid  risk  of  infection.  This  method  of  flush- 
ing with  a  syringe  is  one  of  the  earlier  ones  adopted  by 
Carrel,  to  be  abandoned  later  in  favor  of  irrigation. 
It  does  not  give  as  perfect  results  and  means  more 
work  and  trouble  for  the  attendants,  but  it  may  be 
used  as  an  emergency  substitute,  when  the  ampoules 
and  long  tubes  are  not  available,  with  quite  satis- 
factory results.  It  has  also  the  practical  result  of 
reducing  the  cost  of  the  total  equipment  by  about 
one  third. 

Last  comes  the  question  of  the  antiseptics  that 
should  be  used  in  the  fluid.  The  situation  in  this  cam- 
paign is  not  unlike  the  historic  epigram  of  Henry  of 
Navarre,  on  fighting  in  Spain.  He  declared  it  was  such 
a  poverty-stricken,  hard-hitting  country,  that  if  you 
went  in  with  a  small  army,  you  were  beaten;  with  a 
large  one,  you  were  starved.  In  order  to  get  some 
antiseptic  that  killed  the  germs  without  doing  more 
harm  to  the  tissues  of  the  patient,  after  many  skill- 
ful and  patient  experiments  by  Dr.  Carrel  and  Dr. 
Dakin,  a  young  English  physiologic  chemist  who 
was  Dr.  Carrel's  associate  in  this  part  of  the  work, 


THE  CARREL  TRIUMPH  i6i 

the  ingenious  idea  was  hit  upon  of  devising  an  anti- 
septic which  within  a  short  time  would  be  neutrahzed 
or  made  harmless  to  the  tissues  by  the  lymph  that 
flowed  into  the  wound,  and  yet  which  within  that 
time  would  have  been  able  to  destroy  or  prevent  the 
growth  of  the  germs  present. 

The  chemical  which  they  found  to  fulfill  all  these 
different  requirements  and  give  best  practical  re- 
sults was  not  a  new  one,  but  a  modification  of  an 
old  medical  friend  and  stand-by,  bleaching  powder, 
popularly  known  as  "chloride  of  lime,"  or  "eau  de 
javel"  in  France. 

This  sloppy  white  powder,  which  we  have  all  seen 
and  smelt  sprinkled  about  sinks,  laboratories,  and 
wherever  disinfection  is  supposed  to  be  in  order,  like 
a  good  many  other  common  things  is  rather  a  com- 
plicated body.  But  the  secret  of  it,  put  very  crudely, 
is  that  it  contains  and  conveys  a  small  amount  of 
the  extremely  powerful  and  poisonous  germicide  and 
disinfectant,  chlorine  gas,  and  this  while  very  irri- 
tating at  first,  soon  after  coming  into  contact  with 
the  fluids  of  the  body  and  their  large  content  of  so- 
dium is  changed  into  a  harmless  chloride  of  soda,  or 
common  table  salt. 

Grotesque  and  almost  incredible  as  it  may  sound, 
this  same  poisonous  and  irritating  gas  ^—  chlorine  — 
which  can  be  used  to  kill  germs  and  heal  wounds, 
is  the  one  which  is  the  chief  constituent  of  the 


i62  THE  DOCTOR  IN  WAR 

terrible  poison  gas-clouds  and  gas-shells  as  originally 
devised  by  the  Germans,  and  the  change  to  harm- 
less common  salt,  which  takes  place  in  the  Dakin 
solution  in  wounds,  is  the  same  one  which  enabled 
the  soda-moistened  folds  of  the  earlier  gas-masks  to 
protect  our  soldiers. 

The  Dakin  solution,  of  course,  required  the  most 
elaborate  and  delicate  modification  of  the  chlorine 
powder,  first  to  get  it  of  the  exact  mean  of  strength 
strong  enough  to  do  its  work,  but  not  strong  enough 
to  harm  the  patient,  and  then  to  neutralize,  as  the 
chemists  say,  its  alkalinity  or  **  soap-likeness,"  so  as 
to  prevent  its  irritating  the  skin  of  the  patient  under 
the  dressings  after  it  had  flowed  out  of  the  wound. 
This  was  finally  found  to  be  best  done  by  a  careful 
addition  of  boric  acid,  and  the  perfected  antiseptic, 
^'Dakin's  Fluid,"  is  a  marvel  of  ingenious  and  deli- 
cate adjustment  to  the  particular  work  it  has  to  do. 
It  is  customary  to  color  the  completed  fluid  pink  with 
some  harmless  dyestuff,  so  that  the  nurses  can  see 
the  level  of  it  in  the  glasses  and  ampoules,  as  any 
one  will  see  if  one  visits  the  hospitals,  but  this  has 
nothing  to  do  with  its  antiseptic  effects. 

Finally  comes  the  interesting  and  important  prac- 
tical question.  How  do  we  know  that  this  ingeniously 
adapted  solution  is  doing  the  work  required  of  it, 
killing  the  germs  and  promoting  the  healing  of  the 
tissues?   To  find  the  answer  to  this  question  the  most 


THE  CARREL  TRIUMPH  163 

painstaking  and  thorough  research  and  experimental 
work  of  any  part  of  the  process  were  carried  out  by       ([ 
the  Carrel  staff.   It  is  impossible  to  give  more  than  the         )_3 
very  rudest  explanation,  but  it  may  be  roughly  said         *^    ^ 
that  track  of  the  progress  of  wound  toward  recovery 


is  kept  by  two  entirely  separate  methods,  which>^/^^  C 
keep  check  upon  one  another.  ^      ^ 

One  is  the  daily  counting  of  the  bacteria  which  are 
present  in  the  depths  of  the  wound  itself.  At  the 
time  of  each  dressing,  delicate  instruments  are  intro- 
duced into  the  depths  of  the  wound,  bringing  back 
drops  of  the  fluid  present.  These  are  spread  upon  mi- 
croscopic slides,  stained,  and  the  number  of  bacteria 
contained  in  five  or  ten  dips  counted.  If  the  wound 
is  doing  well,  the  number  of  bacteria  should  diminish 
markedly  from  day  to  day,  and  when  they  have 
fallen  to  a  very  low  level  and  remained  there  for 
several  days,  it  is  then  considered  safe  to  do  the  thing 
so  dear  to  the  heart  of  the  modern  surgeon,  which 
under  pre-war  conditions  would  have  been  the  first 
step;  that  is,  putting  stitches  into  the  lips  of  the 
wound  and  sewing  it  up  tight. 

The  method  is  of  peculiar  value,  because  in  the 
open  treatment  of  wounds,  the  great  difficulty  is  in 
knowing  just  when  it  is  really  safe  to  close  them. 
This  is  vitally  important,  because,  if  they  are  allowed 
to  granulate  up  from  the  bottom,  it  takes  an  enormous 
length  of  time,  and  what  is  almost  as  undesirable, 


i64  THE  DOCTOR  IN  WAR 

leaves  a  huge  and  not  only  disfiguring  but  crippling 
scar. 

A  wound  of  great  length  and  extent  successfully 
treated  by  the  Carrel  method  can  finally  be  closed  up 
and  healed,  with  only  a  little  more  scar  or  deformity 
than  would  be  left  by  the  closing-up  at  once  of  a  clean 
wound.  This  method  diminishes  the  risks  of  crippling 
and  the  number  of  cripples  very  markedly. 

As  for  amputations,  an  eminent  French  surgeon 
made  a  collection  of  over  two  thousand  done  in  the 
earlier  days  of  the  war,  and  found  that  seventy  per 
cent  of  them  were  made  on  account  of  severe  infec- 
tions of  the  wound,  and  at  least  two  thirds  of  these 
could  have  been  prevented  by  the  Carrel  method. 

The  other  method  of  keeping  track  of  the  progress 
of  the  wound  is  the  simple,  but  rather  laborious, 
one  of  measuring  its  actual  superficial  area.  Care- 
fully graduated  calipers  are  employed  and  the  most 
elaborate  mathematical  formulae  for  calculating  the 
square  surface  used,  as  well  as  tracing  the  actual  shape 
and  size  of  the  wound  on  transparent  paper,  then 
transferring  it  to  the  pages  of  the  record. 

On  the  basis  of  thousands  of  cases  followed  and 
recorded  after  this  fashion.  Carrel  has  actually  been 
able  to  work  out  a  mathematical  formula  for  the  rate 
at  which  a  wound  of  given  size  and  depth  in  a  patient 
of  a  given  age,  ought,  under  proper  conditions,  to 
heal. 


THE  CARREL  TRIUMPH  165 

It  would  be  tedious  to  go  into  details,  but  the 
omnipresent  and  universally  employed  "curve"  has 
been  utilized.  A  line  of  curve  is  plotted  that  shows 
the  rate  at  which  a  given  wound,  of  this  size 
ideally  treated,  ought  to  heal,  and  another  curve  is 
plotted  from  the  bacteria-count  test,  and  the  two 
curves  are  found  to  run  closely  parallel.  It  gives  you 
an  almost  uncanny  feeling  to  be  shown,  in  the  his- 
tory room  of  Dr.  Carrel's  splendidly  equipped  hos- 
pital at  Compiegne,  a  diagram  showing  what  is  the 
rate  at  which  a  given  wound  ought  to  heal.  This  was, 
perhaps,  laid  out  fifteen  days  ago;  the  case  is  still 
in  the  wards;  you  go  and  see  what  his  actual  curve 
of  progress  has  been,  and  it  is  seldom  that  the  two 
curves  differ  more  than  five  or  ten  per  cent.  If  the 
surface  of  the  wound  ought  to  be,  say  fifty  square 
centimeters  on  the  fifteenth  day  following,  it  will 
usually  be  between  forty-five  and  fifty-five  square 
centimeters  in  area. 

Then,  with  this  as  a  basis  and  standard,  a  most 
careful  process  of  testing  out  different  antiseptics  and 
methods  is  gone  through  with,  including  all  the  rival 
solutions  which  have  been  suggested  by  other  sur- 
geons or  improvers  upon  this  method.  It  was  fas- 
cinating to  note  how  promptly  and  certainly  a  rapidly 
falling  curve  of  bacteria  in  a  wound  would  turn  and 
rise  within  twenty-four  hours  after  some  less  efficient 
form  of  antiseptic  had  been  employed,  and  how  it 


i66  THE  DOCTOR  IN  WAR 

dropped  back  to  the  normal  again  after  this  had  been 
discontinued. 

Several  other  antiseptic  solutions  besides  the  Dakin 
were  found  to  give  excellent  results  for  some  time, 
in  cases  that  had  started  toward  recovery  under  the 
Dakin,  but  upon  more  prolonged  trial  it  was  found 
they  could  not  be  relied  upon  to  meet  complications, 
which  arose  in  the  form  of  new  outbursts  of  germ 
growth  in  the  wound,  and  the  Dakin  had  to  be  gone 
back  to  to  bring  these  under  control. 

It  would  be  hard  to  imagine  anything  more  abso- 
lutely founded  upon  cold,  actual  demonstration  and 
test,  and  the  feeling  conveyed  is  irresistible  that  if 
any  other  fluid  suggested  had  given  better  results 
than  the  Dakin,  the  latter  would  have  been  promptly 
and  ruthlessly  discarded  in  its  favor. 

Incidentally,  it  may  be  remarked  that  the  age  of 
the  patient  was  found  to  have  a  striking  influence  on 
the  curve  and  the  rate  of  recovery.  The  younger  the 
soldier,  the  more  rapid  the  healing  in  the  beginning, 
which  supports  the  preference  of  military  authorities 
for  young  recruits.  On  the  other  hand,  there  was 
a  curious  after-check,  and  that  was  that  although 
the  wounds  in  the  older  men  healed  much  less  rap- 
idly at  first,  they  began  to  catch  up  later  and  in 
the  end  healed  not  only  as  firmly  and  solidly,  but 
within  fifteen  or  twenty  per  cent  as  soon  as  in  the 
youngsters. 


THE  CARREL  TRIUMPH  167 

The  older  man's  power  of  healing  is  slower  in  the 
beginning,  but  it  arrives  in  the  long  run.  Some  day, 
as  I  suggested  to  Dr.  Carrel,  half  jokingly,  it  may  be 
possible  to  get  from  this  rate  of  wound  healing  some 
sort  of  mathematical  test  as  to  what  is  the  real  age 
of  a  man.  But,  of  course,  no  one  would  venture  to 
hope  for  any  such  certitude  about  the  age  of  a 
woman. 


X 

THE  STRANGLERS 

THIS  is  a  gas  war.  Not,  alas!  a  gas-bag  war,  in 
the  sense  of  long-distance  windy  contests  as  be- 
tween World's  Champions  or  Mexican  Revolution- 
ists, but  in  the  sense  that  gas  is  the  life  breath  of  the 
whole  "show."  Gas  hurls  and  explodes  its  shells  and 
shrapnel;  propels  its  airplanes;  pushes  its  monster 
guns,  its  motor  "camions,"  its  ambulances;  drives  its 
submarines  and  their  chasers;  fills  the  domes  of  its 
censors;  and  serves  directly  as  one  of  the  most  grue- 
some of  its  deadly  weapons.  Less  directly  and  ob- 
viously it  heals  the  wounds  and  purifies  the  drinking- 
water,  for  the  very  same  deadly  chlorine  which  makes 
up  the  bulk  of  the  gas-clouds  is  the  antiseptic  in  the 
Carrel  treatment,  and  in  the  sterilizer  in  the  bleach- 
ing powder  used  to  purify  the  drinking-water  of  the 
armies. 

And  of  all  the  features  of  this  most  terrible  of  wars 
which  have  attracted  the  most  horror-stricken  at- 
tention and  produced  the  most  world-wide  outburst 
of  disgust  and  loathing  against  Germany,  poison  gas 
is  easily  chief.  It  is  hardly  too  much  to  say,  in  the 
language  of  the  standing  form  of  newspaper  reports 
of  suicide,  that  when  Germany  turned  on  the  gas 


THE  STRANGLERS  169 

she  blew  out  her  brains,  so  far  as  hope  of  finally 
winning  the  war  is  concerned.  And  when  the  much- 
debated  question  of  the  name  by  which  this  titanic 
world-struggle  shall  go  down  to  history  is  finally 
settled,  it  may  easily  happen  that  its  title  will  appear 
as  "The  Great  Gas  War." 

And  it  would  be  distinctive,  for  it  is  the  first,  and 
will  most  emphatically  be  the  last,  in  which  this 
atrocity  is  permitted,  unless  God  has  abdicated  in 
favor  of  Germany.  On  my  trips  to  the  Flanders 
Front,  the  most  striking  signs  which  met  the  eye 
everywhere,  in  the  squares  of  the  little  villages,  on 
the  walls  of  the  public  buildings,  and  Headquarters, 
along  all  the  roads  leading  to  the  Front,  were  great 
posters  blazing  the  word  ''Wind  safe"  or  "Wind 
dangerous"  for  gas  attacks;  though,  I  am  happy  to 
say,  for  reasons  explained  later  I  only  saw  the  "Dan- 
gerous" signal  two  or  three  times  in  as  many  weeks. 
And  as  I  first  looked  over  the  kit  of  the  soldiers  most 
of  its  contents  looked  quite  familiar:  there  was  the 
haversack,  the  blanket-roll,  the  canteen,  the  mess- 
tin  and  cup,  the  revolver,  the  rifle,  but  one  prominent 
object  struck  the  eye  as  new  and  strange.  This  was 
a  large  rectangular  case,  or  box,  about  fourteen  inches 
square  by  three  or  four  inches  thick,  slung  from  the 
shoulder  or  round  the  neck  like  a  pair  of  field-glasses. 
Across  its  face  was  printed  in  large  staring  letters 
some  dramatic  warning  in  Italian;  for  instance,  "Chi 


170  THE  DOCTOR  IN  WAR 

si  leva  la  maschlera  muore!"  —  "Who  leaves  the 
mask  dies!" 

Gas  has  proved  a  great  disappointment  to  its  in- 
ventors. There  is  abundant  evidence  to  show  that 
when  the  German  General  Staff  started  their  clouds 
of  strangling  chlorine  rolling  across  the  level  flats 
of  Flanders  toward  the  Canadian  trenches  before 
Ypres,  they  confidently  and  gloatingly  expected 
either  to  send  their  defenders  flying  headlong  in  panic- 
stricken  terror,  or  to  suffocate  them  where  they  stood, 
and  then  come  forward  and  pick  up  the  pieces  and 
occupy  the  position  at  their  leisure.  But  they  swiftly 
bumped  upon  the  two  rocks  which  have  wrecked  their 
whole  programme  of  gas-drives  ever  since.  First, 
that  determined  troops  with  any  kind  of  a  wet  cloth 
tied  over  their  mouths  and  nostrils  will  hold  their 
ground  in  the  thickest  of  gas-clouds.  Second,  that 
if  you  make  your  gas-clouds  thick  enough  seriously 
to  embarrass  the  enemy,  you  find  them  extremely 
uncomfortable  for  your  own  troops  to  charge  into 
for  at  least  one  half  to  three  quarters  of  an  hour 
afterwards. 

While  part  of  the  Canadians  fled,  coughing  and 
gasping,  before  the  ghastly,  green,  choking  cloud  — 
and  who  could  blame  them,  utterly  unprotected  and 
unwarned  as  they  were  —  a  few  stood  their  ground 
doggedly  and  died  in  agony,  while  the  remainder, 
a  considerable  minority,  hastily  grabbed  up  or  tore 


THE  STRANGLERS  171 

off  pieces  of  any  sort  of  cloth  that  they  could  lay 
hands  on  —  first-aid  dressings,  handkerchiefs,  shirts 
—  and  bound  them  respirator  fashion  across  their 
noses  and  mouths. 

This  helped,  but  it  was  n't  enough.  Like  a  flash 
an  inspiration  came  to  one  big  Canadian  sergeant. 
He  tore  off  his  dry  bandage,  saturated  it  by  a  method 
which  is  as  primitive  as  it  is  unfit  for  publication, 
tied  it  on  again,  and  found  he  could  breathe  with 
comfort.  He  ran  down  the  line  shouting  his  discovery. 
Man  after  man  followed  his  example,  and  when  the 
German  shock-troops  came  stumbling  blindly  but 
confidently  through  the  twilight  of  their  own  gas- 
cloud,  to  occupy  the  deserted  trenches,  they  met  such 
a  hot  and  hornet-like  reception  that  very  few  of  them 
went  back  across  No  Man's  Land  to  tell  the  story  of 
their  failure. 

And  this  was  a  fair  sample  of  the  luck  that  has 
attended  gas-attacks  ever  since.  It  is  hardly  too 
much  to  say  that  gas  in  clouds  has  proved  the  great- 
est false  alarm  of  the  war.  In  a  few  instances,  where 
it  has  been  used  upon  "gas-green "  troops  —  that  is 
to  say  —  raw  levies  —  either  unprovided  with  gas- 
masks or  untrained  in  their  use,  as  once  or  twice,  for 
instance,  on  the  Galician  Front  on  the  Dunajec  River, 
and  once  on  the  Italian  Front,  —  it  has  produced 
headlong  flight;  but  it  is  the  opinion  of  some  military 
experts  and  particularly  of  those  on  Boards  of  Gas 


172  THE  DOCTOR  IN  WAR 

Warfare,  that  it  has  seldom  determined  the  result  or 
even  turned  the  scale  in  a  single  important  battle. 
But  when  first  sprung  as  a  surprise  on  unsuspecting 
raw  troops  it  was  sometimes  a  ghastly  success. 

When  used  against  seasoned  troops  with  good 
gas-masks,  though  it  unsettles  their  nerves  and  an- 
noys their  finer  susceptibilities  extremely,  instead  of 
running  away  they  have  a  habit  of  holding  their 
ground,  and  taking  out  their  exasperation  on  the 
storm-troops  that  follow  the  gas-cloud.  While  the 
protection  of  modern  masks,  with  reasonable  vigi- 
lance and  intelligence,  is  so  nearly  perfect  that  while 
precise  figures  are  withheld  for  obvious  reasons,  it 
is,  in  the  opinion  of  those  who  are  in  a  position  to 
know,  doubtful  whether  the  deaths  from  gas  exceed 
one  or  two  per  cent  of  the  total  mortality  of  the 
war.  In  fact  the  only  danger  of  its  further  use  in 
future  wars  is  the  fact  that  it  has  not  proved  as 
deadly  or  as  cruel  as  was  hoped  by  its  inventors. 

For  instance,  on  one  mountainous  section  of  the 
Italian  Front  which  I  visited,  where  very  few  gas- 
attacks  had  been  attempted  by  the  Austrians  on 
account  of  tlie  height  and  direction  of  the  almost 
incessant  mountain  winds,  one  summer  afternoon  it 
fell  calm  and  still,  and  the  fiends  saw  their  chance 
for  a  choice  bit  of  ''Schrecklichkeit"!  From  the 
upper  end  of  a  long,  sloping,  high-walled  valley, 
filled  with  men  and  horses  at  their  evening  meal,  they 


THE  STRANGLERS  173 

launched  their  murderous  clouds,  and  in  twenty  sec- 
onds the  whole  glen  was  a  hell  of  agony  and  death. 
Men,  horses,  mules  rushed  madly  down  it,  strangling, 
gasping,  fighting,  trampling  upon  one  another  in  a  wild 
rush  to  escape  the  deadly  fumes,  but  in  vain.  Some  of 
the  soldiers  had  laid  aside  their  masks,  some  rushed 
panic-stricken  downhill  without  waiting  to  put  them 
on,  others  pulled  them  on  and  then,  feeling  half  suf- 
focated in  their  rush,  tore  them  off  again  to  breathe 
freer.  When  at  last  the  fates  took  pity  and  a  sunset 
breeze  lifted  the  strangling  clouds,  nine  thousand 
men  lay  gasping  and  choking  in  agony,  and  four 
thousand  of  them  died,  in  spite  of  the  most  heroic 
efforts  of  the  doctors!  "It  was  a  glorious  victory,'* 
but  Heaven  help  the  man  or  men  to  whose  account 
it  will  be  charged  in  the  great  Book  of  Judgment,  the 
verdict  of  history!  Moreover,  it  was  utterly  barren 
in  a  military  sense,  as  before  the  valley  was  clear 
enough  of  gas  to  allow  the  Austrians  to  advance  down 
it,  the  Italians  had  thoroughly  lined  its  sides  and 
rim  with  machine  guns. 

In  the  minority  of  cases,  in  which  it  is  successful 
in  driving  back  the  enemy,  it  probably  gains  small 
amounts  of  ground  at  lower  cost  of  life  than  either 
shell-  or  rifle-fire. 

But  it  punishes  the  poor  wounded  terribly,  for 
most  of  the  Dressing-Stations  have  to  be  under- 
ground, and  hence  are  liable  to  be  ''flooded"  with 


174  THE  DOCTOR  IN  WAR 

gas,  which  runs  down  like  water  and  strangles  them 
like  rats  in  a  hole.  Most  Dressing-Stations  I  visited 
in  Flanders  had  an  ''air-lock"  at  the  entrance  con- 
sisting of  a  heavy  blanket-curtain  soaked  in  soda 
solution,  which  you  lifted  to  enter.  Then  it  could  be 
dropped  behind  and  your  clothing  sprayed  with  a 
soda  spray  if  a  ''cloud"  was  on,  then  another  wet 
blanket  in  front  of  you  was  lifted  and  you  entered  the 
tunnel  ward. 

Like  almost  everything  else  in  this  supposedly 
most  modern  and  scientific  of  wars,  there  is  nothing 
new  about  the  use  of  poison-gas.  The  famous  stink- 
pots and  smoke-makers  of  both  Oriental  and  Mediae- 
val warfare  were  exactly  the  same  in  principle  and 
intention.  For  although  the  horrible  reeks  which  they 
gave  off  were  for  the  most  part  as  harmless  as  they 
were  abominable,  they  were  regarded  as  extremely 
deadly  and  held  in  terror  by  the  warriors  on  both 
sides,  on  account  of  the  ancient  mental  association 
between  vile  odors  and  demons  and  devils  and  black 
magic  generally. 

In  fact,  this  method  of  warfare  was  invented  long 
before  the  human  species,  the  most  ancient  and 
honorable  practitioner  of  the  art  being  a  little  beetle, 
styled  by  the  French  "le  bombardier,"  who  when 
frightened  discharges  a  jet  of  most  vile-smelling  and 
acrid  gas  or  spray  in  the  direction  of  his  enemy.  His 
shot  is  most  ingeniously  fired,  too,  the  stink  mixture, 


TRANSPORTING  WOUNDED   TO  A   FIELD   DRESSING-STATION  ON 
THE  SALONICA   FRONT 


BRINGING  IN  A  WOUNDED  CANADIAN  THROUGH  THE  MUD 
ON  THE  WESTERN  FRONT 


THE  STRANGLERS  175 

which  IS  acid,  being  suddenly  discharged  into  a  little 
cavity  under  his  tail  shell,  where  it  meets  an  alkali, 
is  turned  into  a  gas,  and  exploded,  by  the  force  of  its 
own  expansion,  through  the  muzzle  of  his  tiny  trench 
mortar.  Of  course,  the  oniony  ''tear-gas"  spray  of 
the  sable  and  silver  nocturnal  disturber  of  the  peace 
of  our  poultry  yards  is  a  household  word.  The  Ger- 
man Board  of  Gas  Strategy  can  proudly  cite  before 
the  next  Hague  Conference  precedents  as  ancient  as 
they  are  appropriate,  in  the  skunk  and  stink-bug. 

There  is  abundant  evidence  that  the  German  chem- 
ists and  their  laboratory  staffs,  under  the  direction 
of  the  Great  General  StafI:  (like  everything  else  in 
Germany  or  under  a  German  hat,  for  the  last  half- 
century),  had  been  experimenting  industriously  for 
years  to  decide  upon  a  poison  gas  suitable  for  use  in 
war.  This  is  proved  partly  by  the  capture  of  gas- 
containers  stamped  with  the  dates  "Model  of  1909" 
and  ''Model  of  191 1 "  —  I  happen  to  have  been  per- 
sonally assured  of  this  fact  by  a  member  of  the  Bel- 
gian Relief  Commission  who  had  seen  gas-cylinders 
so  dated ;  partly  by  the  fact  that  the  Germans  were  im- 
porting drugs  which  were  of  no  possible  value  except 
for  the  manufacture  of  "tear-gas  '* ;  and  partly  because 
the  very  first  gas  that  they  used  —  chlorine  —  has  re- 
mained the  chief  staple  of  their  gas- clouds  ever  since, 
showing  that  it  was  the  survivor  of  a  long  and  rigid 
series  of  elimination  tests. 


176  THE  DOCTOR  IN  WAR 

The  masks  used  against  gas-clouds  were  simple 
face  bandages  dipped  in  a  solution,  first  of  ordinary 
baking  or  washing  soda,  later  of  sodium  hyposul- 
phite, such  as  is  used  in  developing  photographs, 
because  it  lasted  longer  and  was  less  irritating  to  the 
skin,  and  cans  or  jars  of  this  solution  were  kept  stand- 
ing about  in  the  trenches  to  moisten  the  masks  when 
they  dried  out.  Those  simple  soda  solutions,  by  one 
of  the  blessed  miracles  of  chemistry,  combine  with 
the  burning,  strangling  chlorine  gas  and  turn  it  in 
a  flash  into  harmless  common  table  salt  (sodium 
chloride) !  Later  a  little  glycerin  was  added,  because 
by  its  power  of  attracting  moisture  it  kept  the  masks 
from  drying  up  so  quickly. 

This  was  all  very  well  as  a  temporary  measure,  and 
these  little  home-made,  hand-dipped  masks  did  yeo- 
man service  in  many  a  gas-cloud  for  several  months. 
But  when  it  had  been  recognized  that  gas  was  going 
to  prove  a  permanent  institution  in  this  war,  some- 
thing more  business-like  and  more  effective  was  called 
for.  This  took  the  form  of  a  helmet  or  bag  of  twenty 
or  thirty  layers  of  gauze  with  goggles  of  glass  or  cel- 
luloid for  the  eyes,  pulled  on  over  the  head  and  cap 
or  helmet,  much  like  the  veils  used  by  bee-keepers, 
and  then  tucked  down  under  the  coat-collar  and 
buttoned  in. 

This  was  a  great  improvement,  because  it  not 
only  protected  the  lungs  from  the  poison  gas,  but  also 


THE  STRANGLERS  177 

the  eyes  from  "tear-gas,"  but  it  was  hot,  stuffy,  and 
greatly  limited  the  field  of  vision  as  the  disks  of  glass 
or  celluloid  hung  some  distance  out  in  front  of  the 
eyes.  Moreover,  it  was  found  that  when  phosgene  gas 
began  to  be  extensively  used,  the  bag  or  helmet  mask 
was  a  very  imperfect  protection  against  it. 

So  the  War  Department  called  in  the  chemists  and 
physiologists  and  the  inventors  and  put  their  wits 
to  work,  with  the  result  of  producing  about  two 
years  ago  a  mask  which  is  an  almost  perfect  protec- 
tion against  every  known  kind  of  gas  which  German 
deviltry  has  been  able  to  invent,  which  can  be  worn 
if  necessary  from  twenty-four  to  forty-eight  hours  at 
a  stretch,  which  one  can  sleep  in,  fight  in,  play  foot- 
ball in  if  desired. 

It  is  far  and  away  the  best  mask  in  use  in  all  the 
armies,  and  has  been  adopted  in  its  entirety  with  cer- 
tain additions  and  improvements  by  our  American 
army.  Some  of  the  French  troops  use  it,  and  when 
the  Russians  were  still  our  allies,  a  considerable  num- 
ber of  these  good  masks  were  supplied  to  them.  But 
most  of  the  French,  and  all  the  German,  Austrian, 
and  Italian  troops,  are  still  supplied  with  a  very 
inferior  mask  of  the  "nose-bag"  type,  whose  sole 
advantage  is  that  it  is  cheap,  light,  and  easier  to 
carry  than  the  more  elaborate  English  and  American 
"box"  type. 

For  obvious  reasons,  no  details  of  the  construe- 


178  THE  DOCTOR  IN  WAR 

tion  of  this  mask  can  be  given  except  roughly  to  say 
that  the  air  is  purified  of  gas  by  being  drawn  in, 
not  through  layers  of  gauze,  but  through  an  oval 
box  of  about  the  size  of  a  tomato  can,  filled  with 
whole  layers  of  different  chemicals  and  absorb- 
ents which  can  be  added  to  or  altered  at  will,  as 
new  gases  are  introduced.  As  this  box  respirator 
hangs  down  upon  the  chest  at  the  end  of  a  rubber 
tube  the  size  of  a  large  garden  hose,  this  combined 
with  the  goggles  gives  a  curiously  elephantine,  or 
extinct  monster-like  appearance  to  the  face  of  the 
wearer. 

Some  of  the  German  and  Austrian  masks  also  have 
a  box  respirator,  but  these  are  far  inferior  in  neutral- 
izing and  protecting  power  to  the  English  and  Ameri- 
can ones.  The  feature  which  makes  the  mask  comfort- 
able for  such  long-continued  wear,  is  that  the  breath 
or  expired  air  of  the  wearer  passes  directly  out  into 
the  open  air  through  a  valve  instead  of  being  retained^ 
within  the  mask  to  heat  and  sweat  and  suffocate  him. 
With  this  mask  snugly  strapped  on,  our  American 
and  English  boys  are  perfectly  safe  in  the  densest 
and  most  poisonous  of  gas  clouds. 

Gas  warfare  had  become  a  whole  department  and 
science  in  itself,  first  in  the  German,  and  later  and 
most  reluctantly  in  the  Allied  armies.  But  unfor- 
tunately the  whole  filthy  idea  is  so  utterly  repugnant 
to  our  sense  of  decency  and  fair-play  that  we  have 


THE  STRANGLERS  179 

so  far  contented  ourselves  chiefly  with  countering 
against  each  fresh  deviltry  of  the  Hun  instead  of 
getting  right  down  to  play  the  dirty  game  whole- 
heartedly and  give  him  as  good  as  he  sends  and  one 
better. 

There  are  now  in  use  three  main  groups  of  gases, 
each  containing  two  or  more.  First  of  all,  the  poison 
gases  proper  —  chlorine  and  phosgene ;  then  come 
the  tear-shells,  or,  to  give  their  dictionary  name, 
lachrymatory  gases,  which  is  the  same  thing  done 
into  the  Latin,  whose  object  is  simply  to  irritate  in- 
tensely the  eyes  and  produce  such  a  flood  of  tears 
as  temporarily  to  blind  the  soldier.  Last  and  most 
troublesome  of  all  come  the  irritant  gases  which  at- 
tack chiefly  the  surface  of  the  skin;  these  are  mus- 
tard-gas, nitro-chloroform,  and  a  derivative  of  picric 
acid. 

Then  to  make  matters  still  more  complicated,  any 
or  all  of  these  gases  instead  of  being  discharged  in 
clouds  are  fired  over  in  shells  containing  tubes  of 
them  compressed  into  liquid  form  with  just  enough 
explosive  to  scatter  them  through  the  air.  Indeed, 
mustard  gas  can  be  used  only  in  shells,  because  it  is 
not  a  gas  at  all,  but  a  heavy  liquid,  and  has  to  be 
scattered  through  the  air  in  the  form  of  a  spray  by 
some  explosive. 

"^  Phosgene  is  a  child  or  near  relation  of  chlorine,  its 
textbook  name  being  carbonyl  chloride.    To  put  it 


i8o  THE  DOCTOR  IN  WAR 

very  roughly,  it  is  a  combination  of  chlorine  and 
choke-damp  (carbon  monoxid)  with  all  the  bad  quali- 
ties of  both  parents.  It  is  probably  the  most  intensely 
poisonous  gas  known,  being  fatal  in  about  one  twen- 
tieth of  the  concentration  required  for  chlorine  and 
has  the  ghastly  trick  of  producing  relatively  little 
discomfort  or  suffocation  while  it  is  being  inhaled, 
and  then  suddenly  toppling  over  its  victim  dead  of 
heart  failure  several  hours  later. 

It  is  in  itself  the  answer  to  the  frequently  asked 
question  —  "Why  don't  the  Allies  use  prussic  acid 
and  strangle  the  whole  Hun  outfit?"  Prussic  acid 
to  the  Prussians  would  certainly  be  most  appropriate, 
but  unfortunately  it  is  not  nearly  so  deadly  as  the 
less  famous  phosgene,  and  has  the  great  drawback 
of  being  light  volatile,  and  so  rapidly  escapes  into 
the  surrounding  air  that  it  soon  becomes  too  weak  to 
be  dangerous. 

Phosgene  derives  its  almost  musical  name  from 
the  curious  fact  that  the  two  gases  which  compose 
it  can  be  got  to  unite  only  in  the  presence  of  bright 
light.  Hence,  its  Greek  title,  "light-born."  A  literal 
child  of  light,  but  most  emphatically  not  of  sweetness, 
and  a  doer  of  deeds  of  most  sinister  darkness. 

It  is  much  more  to  be  dreaded  than  chlorine,  be- 
cause it  is  not  only  ten  times  as  poisonous,  but  is 
almost  invisible  and  has  a  much  less  powerful  odor. 
The  latter  is  a  sweetish,  rather  aromatic  scent,  ofh- 


THE  STRANGLERS  i8i 

cially  described  as  resembling  that  of  violets,  though 
to  my  untutored  olfactories  it  more  nearly  suggested 
garlic.  A  full-blown  cloud  of  chlorine  and  phosgene 
combined  is  a  literal  "holy  terror,"  blasting  and 
withering  every  living  green  thing,  grass,  leaves,  gar- 
den crops  along  the  whole  of  its  front  to  a  depth  of 
two  or  three  miles,  and  killing  birds,  insects,  and 
small  animals,  three  and  even  four  miles  behind  the 
front  trenches!  The  only  living  thing  that  can  sur- 
vive it  is  men  or  horses  in  gas-masks,  and  it  has  one 
small  redeeming  feature,  that  it  destroys  all  the 
vermin  in  the  trenches  and  dug-outs;  not  a  rat,  nor 
a  cockroach,  nor  even  a  flea  or  a  cootie  being  left 
alive. 

The  cloud-attack  method  of  using  poison  gas  proved 
a  great  disappointment  to  the  Hun  chemists  and  com- 
manders, and  has  already  been  practically  laid  on 
the  shelf  for  the  past  year  or  more  in  favor  of  gas- 
shells.  Indeed,  it  was  a  good  deal  of  a  boomerang, 
and  even  more  unpopular  among  the  German  troops 
than  it  was  among  our  own.  This  for  the  reasons, 
first,  that  there  was  a  perfectly  tremendous  amount 
of  extremely  hard  and  dangerous  work  in  preparing 
for  an  attack,  thousands  of  the  great  gas  cylinders 
weighing  from  ninety  to  one  hundred  and  twenty 
pounds,  having  to  be  carried  by  hand  into  the  front- 
line trenches,  at  the  rate  of  one  to  each  yard  of  the 
two  to  four  mile  front  to  be  gassed.   Indeed,  in  some 


i82  THE  DOCTOR  IN  WAR 

of  the  last  attacks  they  were  placed  three  to  every 
two  yards! 

In  the  second  place,  this  whole  process  was  lit- 
eral playing  with  fire,  for  if  a  single  fragment,  from 
any  one  of  the  continual  rain  of  shells  falling  into 
the  front-line  trenches  happened  to  strike  a  cylinder, 
there  would  be  at  least  a  dozen  dead  and  thirty  to 
fifty  badly  gassed  Germans  at  once.  Third,  and  not 
least,  by  a  strange  oversight  on  the  part  of  the  All- 
wise-and-everything- fore- thinking  General  Staff,  they 
failed  to  take  into  account  that  the  battle-line  of  the 
Western  Front  runs  mainly,  roughly  speaking,  from 
north  to  south,  and  that  the  prevailing  winds  of  the 
temperate  zone  during  the  summer  are  from  two 
thirds  to  three  fourths  of  the  time  from  the  westerly 
quarters.  Therefore,  the  wind  is  favorable  for  carry- 
ing Allied  gas-clouds  into  the  German  trenches  just 
about  three  times  as  often  as  it  is  for  carrying  Ger- 
man clouds  into  our  trenches. 

To  make  it  worse  yet,  not  only  high  winds,  but 
any  winds  above  ten  miles  an  hour  whisk  the  gas 
about  and  scatter  it  so  quickly  as  to  make  it  almost 
harmless.  The  only  winds  upon  which  gas-clouds 
can  be  used  effectively  —  the  light  ones  from  four  to 
eight  miles  an  hour  —  are  the  very  ones  which  are 
most  likely  to  whirl  about  and  carry  the  cloud  back 
into,  or  what  is  even  worse,  up  or  down,  the  German 
trenches.    And  even  the  good  old  German  God  has 


THE  STRANGLERS  183 

declined  to  interfere  and  correct  this  strange  perver- 
sity of  the  weather,  in  favor  of  his  chosen  people. 

In  one  blessed  instance  the  wind,  after  chopping 
about  and  holding  the  cloud  in  No  Man's  Land  for 
twenty  minutes,  swung  completely  round  and  swept 
it  back  into  the  Hun  trenches  killing  eleven  hundred 
and  disabling  over  five  thousand  of  their  own  soldiers. 

One  of  the  first  methods  of  attacking  and  dispersing 
the  gas-clouds  themselves  was  literally  fighting  the 
devil  with  fire.  That  is  to  say,  accumulating  at  va- 
rious points  along  and  behind  the  trenches  piles  of 
brushwood,  straw,  or  other  inflammable  trash,  sprin- 
kled with  petroleum,  not  unlike  the  smoke-pots  and 
smudge-heaps  scattered  about  through  the  orchards 
of  Southern  California  to  be  lighted  to  protect  the 
oranges  against  frost. 

Whenever  a  gas-cloud  is  launched,  all  these  quick- 
burning  piles  down  the  wind  from  it  are  lighted,  and 
the  result  is  a  swift,  upward-rushing  current  of  hot 
air  which  catches  the  gas  and  carries  it  into  the  upper 
layers  of  the  atmosphere,  at  the  same  time  neu- 
tralizing it  by  the  gases  and  fragments  of  organic 
matter  in  the  smoke.  This  is  quite  an  effective  pro- 
tection when  skillfully  carried  out,  and  the  French 
Surgeon-General  with  whom  I  visited  assured  me 
that  in  regions  where  gas  was  frequently  used  even 
the  animals  came  to  know  the  meaning  of  it,  and 
horses,  dogs,  mules,  and  cats  rushed  to  and  crowded 


1 84  THE  DOCTOR  IN  WAR 

round  the  fires  —  having  no  gas-masks,  poor  beasts. 
They  were  led  to  the  fires  for  safety  in  the  first  place 
by  the  men  who  had  them  in  charge,  but  after  a  few 
experiences  all  that  was  needed  was  to  turn  them  loose 
and  they  would  rush  eagerly  to  these  safety  spots. 

I  found  quite  an  ingenious  device  adopted  in  the 
Italian  Army  on  this  same  principle  —  sticking  little 
hedges  or  rings  of  short,  cone-shaped  torches,  soaked 
with  petroleum,  across  the  front  of  all  gun  batteries 
and  gun  emplacements  below  the  level  of  the  ground. 
These  torches  are  provided  with  a  fulminate  so  that 
whenever  a  gas-shell  explodes  anywhere  near  them 
they  "go  off"  and  burst  into  flames,  thus  carrying 
up  the  gas-fumes  and  preventing  them  from  pouring 
down  into  the  gun-pits. 

The  second  type  of  war  gases,  the  lachrymators 
("weepers")  or  "tear-gas"  shells,  can  be  quickly 
dismissed.  As  their  names  imply,  they  are  vapors, 
which  are  not  actively  poisonous  or  strong  enough  to 
burn  or  blister  the  skin,  but  are  intensely  irritating 
to  the  eyes,  producing  such  profuse  and  uncontrol- 
lable floods  of  tears  that  the  soldier  for  some  minutes, 
or  even  an  hour  or  more,  is  practically  completely 
blinded  by  them,  and  of  course  for  the  time  being  is 
of  very  little  use  for  fighting  purposes. 

In  the  beginning  the  chief  German  "tear-gas'*  was 
made  from  the  seeds  of  a  tropical  grass  known  as 
"sabadilla,"  and  discovered  by  the  extreme  annoy- 


THE  STRANGLERS  185 

ance  which  It  caused  to  laborers  clearing  the  Central 
American  jungle  for  rubber  or  cocoa  plantations. 
It  transpired  that  Germany  had  been  importing 
these  seeds  by  the  ton  for  years  past,  for  what  pur- 
pose no  one  could  guess  until  the  war  broke  out ! 

Of  course,  as  soon  as  German  commerce  was  swept 
from  the  seas  by  the  English  Navy,  this  source  of 
*' tear-gas"  was  cut  off,  and  they  have  since  been 
using  an  intensely  "oniony*'  synthetic  compound 
known  as  xylyl  bromide.  And  another  whose  name 
is  utterly  incapable  of  pronunciation,  except  that  it 
has  a  "form"  in  it,  which  gives  a  formalin  clue  to 
one  secret  of  its  weepiness. 

These  "tear-gases"  are  always  fired  in  shells,  and 
while,  as  one  authority  expresses  it,  they  have  added 
somewhat  to  the  discomforts  of  an  already  uncom- 
fortable war,  they  have  not  proved  of  any  great 
practical  value.  It  is  reported  that  one  or  two  small 
detachments,  surprised  by  them  when  they  were  first 
used,  were  attacked  and  captured  while  temporarily 
blinded,  but  the  troops  were  quickly  provided  with 
goggles  whose  rims  were  backed  with  spongy  rubber 
cushions,  fitting  air-tight  to  the  face,  and  completely 
protecting  against  the  "weepers." 

The  last  group  of  the  gases,  the  irritants  or  blis- 
terers,  while  fortunately  not  dangerous  to  either  life 
or  eyesight  if  the  mask  is  worn,  are  the  most  prac- 
tically troublesome  and  annoying  of  the  whole  lot, 


i86  THE  DOCTOR  IN  WAR 

and  far  the  most  heavily  used.  It  is  estimated  that 
in  some  of  the  recent  preliminary  bombardments, 
from  a  third  to  a  half  of  the  shells  fired  of  all  descrip- 
tions, were  gas-shells  or  mustard-gas. 

This  last  is  the  gas  masterpiece  of  the  General 
Staff  and  is  a  peculiarly  German  vapor,  being  sneaky 
because  it  is  invisible  and  almost  odorless,  murderous 
to  the  wounded  because  it  will  hang  about  for  days 
or  even  weeks  in  shell-holes  or  abandoned  dug-outs 
just  waiting  for  them  to  fall  into  it,  and  peculiarly 
vicious  and  painful  in  its  attack  upon  the  skin  of  the 
body,  which  it  burns  like  liquid  fire  or  scalding  steam. 
It  has  nothing  to  do  with  mustard,  but  is  a  syn- 
thetic or  specially  constructed  compound  known  in 
chemical  circles  as  chloro-ethyl  sulphide. 

The  only  warning  given  by  this  gas  is  a  faint  mus- 
tard-like smell  and  a  slightly  sweetish,  pungent  taste 
in  the  mouth,  instantly  recognized  by  those  who 
have  once  experienced  it.  In  the  beginning  it  caused 
quite  a  number  of  deaths  because  the  troops,  not 
being  familiar  with  the  odor,  did  not  put  on  their 
gas-masks  until  it  was  too  late,  and  when  you  breathe 
mustard  gas  deep  into  your  lungs  the  consequences 
are  much  the  same  as  when  you  breathe  in  flame  in 
a  burning  building.  It  literally  burns  the  linings  out 
of  your  bronchial  tubes  and  you  have  about  a  fifty- 
fifty  chance  of  dying  of  septic  pneumonia  a  week  or 
ten  days  later. 


THE  STRANGLERS  187 

I  happened  to  see  scores  of  these  mustard-gas  pneu- 
monia cases  in  the  Allied  Base  Hospitals,  last  au- 
tumn, when  the  beastly  stuff  was  first  used,  and  hun- 
dreds of  the  skin  burns,  and  they  were  a  pitiful  sight. 
One  great  group  of  hospitals  alone  had  had  five  thou- 
sand cases  and  nea;rly  one  thousand  deaths.  The 
worse  cases  of  all  were  those  of  wounded  who  had 
fallen  into  holes  full  of  this  treacherous  gas  and  who 
had  to  lie  there  for  hours,  and  of  one  half  company 
of  soldiers,  who  had  gone  back  to  their  dug-out  to 
rest,  not  knowing  that  it  had  been  shelled  and  filled 
with  mustard-gas  in  their  absence.  They  actually 
lay  down  in  their  bunks  and  went  to  sleep  without 
detecting  the  stuff,  and  woke  up  a  couple  of  hours 
later,  literally  burning  alive,  both  inside  and  out,  and 
although  they  were  able  to  struggle  up  to  the  surface 
and  get  taken  to  the  hospital,  over  half  of  them  died. 

But  this  was  only  in  the  surprise  period,  when  the 
troops  were  unfamiliar  with  the  engaging  little  pe- 
culiarities of  mustard-gas,  and  the  report  was  spread 
up  and  down  the  trenches  that  it  would  go  right 
through  the  gas-masks.  As  soon  as  they  were  reas- 
sured that  the  mask  was  a  complete  protection  to 
both  lungs  and  eyes,  and  were  warned  of  its  lack  of 
odor  and  its  habit  of  lying  in  shell-holes  and  in  dug- 
outs unless  they  were  thoroughly  fanned  or  sprayed 
out  before  being  occupied,  it  ceased  to  be  seriously 
dangerous. 


i88  THE  DOCTOR  IN  WAR 

At  that  time  we  could  tell  gas-shells  from  ordinary 
shells  by  the  fact  that  they  made  but  a  feeble  report, 
being  loaded  only  with  just  enough  explosive  to 
scatter  their  poisonous  cloud  abroad  through  the  air. 
So  that  the  veteran  soldier,  as  soon  as  he  noticed  that 
many  of  the  shells  in  his  neighborhood  seemed  to 
be  ''duds,"  or  failed  to  explode  properly,  promptly 
suspected  gas-shells  and  reached  for  his  mask.  But 
the  German  Gas  Board  quickly  "caught  on"  and 
remedied  that  little  defect  by  increasing  the  charge 
of  explosive,  so  as  to  make  a  gas-shell  as  loud  as  an 
ordinary  shell.  Hence,  the  troops  now,  as  soon  as  any 
serious  bombardment  commences,  put  on  their  gas- 
masks as  a  matter  of  routine.  This,  of  course,  does 
not  protect  them  against  the  burning  effect  of  the 
gas  upon  their  bodies.  But  it  has  been  found  that, 
unless  they  are  actually  drenched  with  the  gas  — 
or,  more  accurately,  sprayed,  because  mustard -gas  is 
not  a  gas,  but  a  liquid  —  by  the  bursting  of  a  shell 
within  twenty  feet,  or  lie  for  some  time  in  a  shell- 
hole  or  trench-bay  or  dug-out,  which  is  filled  with 
the  gas,  it  will  not  soak  through  their  clothing  in 
sufficient  amounts  to  do  much  harm. 

If  a  mustard-shell  bursts  actually  in  a  trench,  its 
fumes  can  be  fanned  out  by  vigorous  use  of  boards 
or  paddles,  or  a  sort  of  wicker  fan  provided  for  the 
purpose;  while  I  was  assured  that  if  a  soldier  gets 
his  clothing  saturated  by  the  landing  of  a  gas-shell 


THE  STRANGLERS  189 

within  twenty  feet  and  begins  to  feel  the  "bite"  of 
the  gas  on  his  skin,  and  can  promptly  throw  off  his 
clothing  he  will  escape  with  only  a  few  blisters.  He 
has  to  count  himself  as  a  light  casualty  and  go  to  the 
rear  with  the  rest  of  the  wounded,  and  if  he  does  this 
promptly  enough  all  will  be  well.  His  literal  "dress- 
ing "  will  not  take  very  long,  and  he  will  soon  be  back 
on  the  firing-line  again. 

,  The  gas  cannot  attack  the  surface  of  the  body 
where  it  is  dry,  but  only  where  the  skin  is  moist  from 
perspiration,  as  under  the  collar,  round  the  hat-brim, 
under  the  arm-pits,  etc.  Bad  as  mustard-gas  is,  if 
a  soldier  puts  on  his  gas-mask  promptly  and  counts 
himself  as  a  light  casualty  whenever  a  gas-shell 
explodes  within  twenty  feet  of  him,  he  will  side-step 
nine  tenths  of  its  dangers.  Its  one  redeeming  fea- 
ture is  that  the  burns  of  the  skin  produced  by  It, 
though  fierce  and  painful,  are  quite  superficial,  and 
although  very  slow  in  healing,  because  the  gas  seems 
to  poison  as  well  as  to  burn,  they  leave  no  scars;  and 
even  the  eyes  which  have  been  caught  unprotected 
by  goggles  are  not  permanently  damaged  by  it.  As 
an  illustration  of  the  heavy,  clinging  character  of 
this  gas,  nurses  undressing  wounded  men  whose 
clothing  has  been  soaked  with  it  will  get  their  fin- 
gers burnt  unless  they  wear  rubber  gloves. 

As  for  the  treatment  of  gas-poisonings,  far  and 
away  the  best  cure  is  prevention  and  the  most  po- 


190  THE  DOCTORIN  WAR 

tent  remedy  is  a  little  word  of  four  letters,  m-a-s-k. 
By  the  prompt  and  vigilant  use  of  the  box-mask,  not 
only  the  fatalities,  but  severe  gassings  have  been 
cut  down  to  only  a  few  in  a  thousand  of  the  troops 
attacked,  for  nearly  two  years  past.  It  was  in  fact 
the  perfection  of  the  gas-mask  and  of  the  allied  gas- 
drill  and  systems  of  warning  that  caused  the  German 
Staff  practically  to  abandon  the  gas-clouds  or  gas- 
waves  on  the  Western  Front.     - 

The  details  of  this  drill  have  become  literally  a 
household  word,  since  so  many  of  us  have  boys  of 
our  own  or  friends  in  the  training-camps.  The  young 
recruit  is  first  trained  in  putting  on  the  mask  snugly 
and  learning  to  breathe  comfortably  in  it,  first  at 
rest,  then  walking,  and  finally  running,  drilling, 
working,  and  even  playing  football.  Then  comes  the 
"gas-house,"  where  he  is  dosed  with  first  a  mild,  and 
later  a  strong,  concentration  of  the  gas  so  as  to  learn 
confidence  in  his  mask.  Finally,  with  his  gas-mask 
in  the  "alert''  position  strung  high  across  his  chest, 
the  alarm  is  sounded,  followed  thirty  seconds  later 
by  the  "wave."  This  sounds  rather  swift,  but  as  the 
standard  time  for  hustling  into  a  gas-mask  is  ten 
seconds  from  the  "alert"  and  fifteen  from  the 
"carry"  position,  and  it  has  been  known  to  be  done 
in  four,  there  is  ample  margin. 

Every  possible  precaution  is  taken,  as  both  Eng- 
lish and  French  officers  assured  me  that  sergeants 


THE  STRANGLERS  191 

and  corporals  have  to  keep  the  sharpest  lookout  upon 
the  files  as  they  first  march  into  the  literal  ''lethal 
chamber,"  for  in  every  hundred  youngsters  there  will 
nearly  always  be  found  one  or  two,  who,  in  spite  of 
all  coaching  and  assurances,  are  smitten  with  panic 
and  lose  their  heads  completely  at  the  first  whiff  of 
the  chlorine  and  clutch  wildly  at  their  masks  to  tear 
them  off,  and  only  the  promptest  seizing  and  hustling 
instantly  neck  and  crop  out  of  doors  will  save  them 
from  serious  strangling!  And  I  don't  mind  confess- 
ing a  deep  sympathy  with  and  for  those  poor,  terror- 
crazed  young  rookies. 

But  supposing  some  accident  had  happened,  that 
a  man  has  been  wounded  before  the  alarm  was 
sounded,  or  a  shell  fragment  has  torn  his  gas-mask; 
even  then  the  chances  are  ten  to  one  against  any  se- 
rious result.  He  is  promptly  seized  by  his  comrades 
or  the  stretcher-bearers  and  an  extra  mask  hustled 
over  his  head,  or,  if  none  is  available,  a  heavy  wet 
bandage  is  tied  over  his  mouth  and  nose,  and  he  is 
hurried  with  the  wounded  to  the  rear. 

The  best  remedy  against  chlorine  and  phosgene 
is  another  gas  —  oxygen  —  and  all  Casualty  Clear- 
ing-Stations and  Evacuation  Hospitals,  and  many 
Advanced  Dressing-Stations  are  equipped  with  a 
cylinder  of  oxygen  with  a  multiple  nozzle,  so  that 
eight  or  ten  tubes  can  be  attached  to  it,  for  the  treat- 
ment of  as  many  gas  victims  at  once. 


192  THE  DOCTOR  IN  WAR 

A  gassed  soldier  is  treated  strictly  as  what  the 
English  call  a  '*lier''  and  the  French  a  "grand 
bless6"  C'heap  wounded"),  and  carried  on  a 
stretcher  in  spite  of  his  indignant  protestations  that 
he  is  perfectly  able  to  walk,  because  the  great  dan- 
ger from  phosgene  is  death  by  heart  failure  during 
exertion  an  hour  or  so  after  the  gassing. 

Officers  who  have  flatly  refused  to  leave  the  trenches 
have  been  known  to  fall  dead  while  shouting  com- 
mands to  their  men.  But  if  the  phosgene-gassed  man 
is  kept  completely  at  rest  for  four  or  five  hours,  he 
is  almost  entirely  safe  from  this  disaster.  Unless  he  is 
suffering  a  great  deal  of  distress  in  breathing,  it  is 
considered  safer  to  keep  him  in  the  first  shelter  where 
there  is  room  for  him  to  lie  down  comfortably,  even 
at  some  little  risk  of  shell-fire,  rather  than  put  him  to 
the  strain  of  being  carried  back  to  the  Dressing- 
Station  or  Hospital  where  he  can  get  oxygen. 

If  much  chlorine  has  been  inhaled,  nothing  relieves 
the  agonized  gasping  and  struggling  for  breath  like 
oxygen,  and  I  have  seen  three  and  four  patients  at  a 
time  lying  on  cots  around  the  blessed  oxygen  tank, 
each  sucking  away  at  a  tube  contentedly,  as  com- 
fortable as  kittens,  and  on  the  highroad  to  recovery. 
In  severe  cases  of  gassing  with  chlorine,  prompt 
bleeding  —  the  old-fashioned  blood-letting,  or  vene- 
section —  often  gives  great  relief,  because  it  drains, 
as  it  were,  the  dreadful  edema  or  watery  swelling 


THE  STRANGLERS  193 

of  the  tissues  of  the  lungs,  produced  by  chlorine  gas, 
which  is  the  chief  cause  of  suffocation  and  death. 

This  was  very  popular  at  one  time  in  both  the 
German  and  the  French  Army,  but  it  has  now  been 
abandoned  or  only  used  where  oxygen  cannot  be  had, 
because  it  does  not  relieve  any  more  rapidly  than 
oxygen  does,  and  has  no  curative  effect  at  all,  the 
distress  coming  back  again  in  the  course  of  an  hour 
or  two.  Another  extremely  prompt  and  effective 
remedy,  which  is  at  present  a  military  secret,  has 
recently  been  worked  out  by  our  own  American  Gas 
Investigation  Board  at  New  Haven. 

Altogether,  what  with  rest,  oxygen,  and  blood- 
letting in  dire  emergencies,  the  death-rate  from  gas 
poisoning  has  been  cut  down  to  less  than  ten  per 
cent  —  in  some  hospitals  that  I  visited  to  less  than 
five  per  cent.  So  that  the  word  "gassed"  no  longer 
fills  us  with  the  sense  of  helpless  and  hopeless  horror 
which  the  sight  of  those  first  green-face  specters  of 
men,  gasping  and  frothing  at  the  mouth  in  mortal 
agony  in  the  earlier  gas-clouds,  had  indelibly  im- 
pressed upon  our  minds. 

My  most  courteous  guide  and  conductor  through 
the  front-line  hospitals  of  one  of  the  English  armies 
happened  to  be  the  surgeon  into  whose  Dressing- 
Station  behind  Ypres  were  carried  some  forty  of  the 
victims  of  the  first  gas-attack.  And  he  said  that  never 
until  his  dying  day  could  he  forget  that  scene,  the 


194  THE  DOCTOR  IN  WAR 

distorted  countenances  and  sobbing  agony  of  the 
poor  fellows,  and  his  own  utter  sense  of  helplessness 
to  do  anything  to  relieve  them. 

Fortunately,  however,  those  dreadful  scenes  did 
not  last  long,  and  since  the  introduction  of  the  mask, 
I  have  not  been  able  to  find  any  hospital  along  the 
whole  of  both  the  British  and  French  Fronts  which 
had  had  a  mortality  of  more  than  twenty  per  cent 
in  its  gas  cases  even  before  the  use  of  oxygen. 

But  what  of  those  who  recover  from  gassing?  How 
permanently  are  they  damaged  and  what  is  their 
future  outlook?  Here  again  I  was  agreeably  sur- 
prised, because  I  had  heard  many  and  widespread 
rumors,  not  only  among  the  public,  but  in  the  medi- 
cal profession,  to  the  effect  that  any  man  who  had 
once  been  badly  gassed  was  practically  ruined  for 
life  and  never  fit  for  active  duty  again.  On  the  con- 
trary, I  found  that  the  great  majority,  probably  at 
least  seventy  per  cent,  including,  of  course,  the 
lighter  cases,  recovered  as  completely  as  they  would 
have  done  from  an  ordinary  pneumonia  or  a  bron- 
chitis, and  were  back  again  on  the  firing-line,  appar- 
ently as  well  as  ever,  in  a  month  or  six  weeks. 

A  considerable  minority,  however,  perhaps  a  fifth, 
were  left  in  a  wheezy,  asthmatic,  chronic  bronchitic 
condition  which  lasted  for  several  months,  and  in 
some  cases  a  year  or  more,  and  which  temporarily 
unfitted  them  for  active  service,  but  even  most  of 


THE  STRANGLERS  195 

these  seemed  to  clear  up  finally  and  recover  almost 
completely.  A  small  number  seemed  to  be  rendered 
permanently  asthmatic,  particularly  among  men 
over  forty. 

As  to  the  widespread  popular  belief  that  gassing 
was  peculiarly  liable  to  be  followed  by  tuberculosis, 
and  that  we  should  need  large  hospitals  for  the  ac- 
commodation of  the  consumptive  soldiers  rendered 
tubercular  by  gas,  I  could  find  no  foundation  for  it, 
even  after  visiting  not  merely  the  Field  and  Base 
Hospitals,  but  a  number  of  the  special  sanatoria  and 
hospitals  for  consumptive  soldiers  in  both  France 
and  Italy;  except  that  in  about  a  dozen  cases,  men 
who  were  known  to  have  been  tuberculous  before 
they  entered  the  army,  and  had  the  disease  in  a  rest- 
ing stage,  suffered  a  relapse  after  being  gassed. 

It  is,  of  course,  too  early  to  speak  positively  about 
two  such  extremely  chronic  diseases  as  consumption 
and  bronchial  asthma,  but  so  far  apparently  not  more 
than  one  or  two  per  cent  of  those  gassed  have  de- 
veloped either  of  these  diseases. 

For  mustard-gas,  if  inhaled  deeply  and  long  enough, 
there  is  no  effective  treatment,  because  no  known 
drug  will  supply  the  bronchial  tubes  and  air  pas- 
sages with  new  linings  to  take  the  place  of  the  old 
ones  which  have  been  literally  burnt  out.  But  one 
half  to  two  thirds  even  of  these  cases  fight  their  way 
through  to  recovery  from  their  septic  pneumonia, 


196  THE  DOCTOR  IN  WAR 

and  they  are  now  quite  few  in  number,  since  the 
troops  have  learned  to  put  on  their  gas-masks  at  the 
first  suspicion  of  gas-shells  in  a  bombardment. 

Altogether,  what  with  the  box-masks,  gas-drills,  a 
perfect  system  of  gas-alarms  by  means  of  great  Strom- 
bos  horns  driven  by  compressed  air,  fans  and  paddles 
of  various  sorts  for  driving  the  gas  out  of  the  trenches, 
and  the  Vermorel  anti-gas  spray,  which  cleans  the  air 
of  trenches  and  dug-outs  by  precipitating  chlorine 
with  a  chemical  spray,  the  percentage  of  deaths,  or 
of  even  serious  poisonings  or  burnings,  by  gas  has  been 
reduced  to  a  very  small  one.  The  great  German  gas 
drive  has  been  completely  checked,  if  not  actually 
checkmated. 


XI 

THE  DRINKING-WATER  OF  THE  SOLDIER 

WATER,  in  spite  of  its  proverbial  "weakness** 
and  instability,  is  one  of  the  chief  sinews  of 
war,  not  only  in  the  fundamental  sense  that  every- 
thing about  us  which  is  really  alive  swims  under 
water,  and  dryness  spells  death  —  "dusty  death'* 
as  Macbeth  calls  it  —  but  also  from  three  purely 
military  and  local  points  of  view:  First,  the  soldier 
needs  water  to  fight  on  ■ —  a  regiment  in  action  with- 
out water  becomes  useless  almost  as  quickly  as  one 
without  ammunition.  Second,  because  the  wounded 
are  desperately  in  need  of  water,  on  account  of  the 
drainage  of  their  bodies  by  loss  of  blood.  Hence,  the 
apparent  paradox  that  the  wounded  who  have  to 
lie  out  on  the  field  in  rain  and  even  in  snow  suffer 
far  less  and  keep  in  better  condition  than  those  who 
fall  in  dry  hot  weather.  Numerous  instances  are  on 
record  in  this  war  of  men  who  have  fallen  wounded 
in  some  remote  or  hidden  shell-crater  and  have  lain 
there  in  rain,  sleet,  and  even  snow  for  from  five  to 
seven  days,  and  have  then  been  picked  up  not  merely 
alive,  but  in  condition  to  make  a  rapid  recovery. 
A  man  will  stand  a  lot  of  cold  and  a  lot  of  soaking, 
but  he  bears  drying  very  badly.    One  instance  re- 


198  THE  DOCTOR  IN  WAR 

lated  to  me  by  a  surgeon  friend  to  whose  hospital 
the  wounded  man  was  brought  establishes  a  new 
world's  record  in  human  endurance.  He  had  Iain  out 
in  a  shell-hole  in  No  Man's  Land,  or  rather  behind 
the  first  German  line,  ior fifty-one  days  in  wet  weather 
with  a  shattered  leg,  drinking  the  rain  water  which 
pooled  in  the  shell-hole  and  living  on  the  "  iron  ra- 
tions "  in  the  knapsacks  of  the  dead  bodies  around  it 
within  the  area  over  which  he  could  drag  himself  on 
his  hands  and  one  knee  during  the  nights !  Thirdly, 
because  water  is  one  of  the  chief  means  of  convey- 
ance and  spread  of  the  three  great  camp  plagues  or 
army  fevers,  typhoid,  cholera,  and  dysentery.  These 
three  plagues  in  historic  times  followed  the  colors  as 
surely  as  the  vultures  did,  because  the  very  first  thing 
which  an  army  without  modern  first-class  sanitary 
service  does  in  the  field  is  to  foul  its  own  water- 
supply. 

Kipling  has  vividly  expressed  the  vital  necessity 
of  water  to  the  fighting  man  in  his  famous  ballad 
of  "GungaDin":  — 
*'  You  may  talk  of  gin  an'  beer,  w'en  you're  quartered  safe 
back  here, 

With  your  little  penny  fights  and  Aldershot  it, 

W'en  it  comes  to  bloody  slaughter,  you  will  do  your  work 
on  water, 

An'  you  '11  lick  the  bloomin'  boots  of  'im  that 's  got  it." 

The  water-supply  for  an  army  in  the  field  is  an  ex- 
tremely difficult  and  perplexing  problem,  as  vexing 


DRINKING-WATER  199 

as  it  is  vital.  It  was  on  account  of  its  desperate  and 
apparently  hopeless  struggles  with  the  problems  of 
water-supply,  or,  what  is  simply  another  way  of  put- 
ting it,  sewage-disposal,  that  sanitation  came  to  be 
regarded  as  one  of  the  dismal  sciences. 

Even  leaving  out  of  count  altogether  such  trivial 
details  as  purity  and  wholesomeness,  it  is  often  under 
modern  war  conditions  difficult  to  get  a  sufficient 
amount  of  just  plain  wetness  for  an  army  or  a  unit. 
This  at  first  sight  seems  incredible,  because  there 
appear  to  be  rivers  and  streams  almost  everywhere 
rambling  over  the  face  of  the  planet,  and  where  there 
are  no  rivers  there  are  ponds  and  wells. 

But  unfortunately  modern  armies  have  to  live 
along  or  near  trenches,  and  trenches  cannot  always 
be  dug  in  river  valleys;  in  fact,  they  very  seldom 
can,  on  account  of  difficulties  of  drainage  and  flood- 
ing; hence  the  Front  usually  runs  along  the  tops  of 
ridges.  Along  those  ridges  there  may  be  scattered 
a  few  villages,  each  with  its  wells  or  springs,  and  be- 
tween them  an  occasional  well  or  dew  pond. 

But  when  you  remember  that  the  soldier  popula- 
tion of  the  Western  Front  is  over  ten  thousand  to  the 
mile,  then  the  triffing  supply  sufficient  for  the  rural 
population  becomes  a  mere  drop  in  the  bucket.  Es- 
pecially in  view  of  the  fact  that  that  rural  popula- 
tion never  drinks  water  when  it  can  possibly  help  it, 
and  considers  itself  punctilious  to  the  verge  of  ab- 


20O  THE  DOCTOR  IN  WAR 

surdity  if  it  takes  a  bath  once  a  year.  This  is  no 
mere  figure  of  speech;  there  are  scores  of  old  men  in 
these  villages  who  cannot  remember  the  date  of  their 
last  bath,  and  I  have  seen  a  copy  of  a  prospectus  of 
a  famous  boys*  school,  about  thirty  years  ago,  in 
one  of  the  chief  Continental  cities,  in  which  a  full 
section  is  devoted  to  the  proud  announcement  that 
parents  may  feel  confident  that  the  health  of  their 
children  will  be  most  strictly  guarded,  for  they  will 
receive  regularly  one  foot-bath  each  week  and  one 
full  bath  ("grand  bain")  each  month! 

In  mountainous  regions  like  most  of  the  Italian 
Front,  and  particularly  the  Carso,  all  the  water  for 
the  troops,  not  only  in  the  trenches,  but  also  in  the 
support  and  part  of  the  reserve  lines,  has  to  be  hauled 
from  two  to  five  miles  in  tanks  or  water-carts  or 
huge  casks,  and  if  the  Austrian  gunners  can  succeed 
in  spotting  the  row  of  casks  or  concrete  tank  in  which 
the  water-supply  for  the  first-line  is  stored  upon  the 
top  of  the  mountain,  and  drop  a  batch  of  shells  into 
it,  they  are  as  pleased  as  if  they  had  blown  up  an 
ammunition  dump. 

Even  along  such  moderate  elevations  as  the  ridges 
of  the  Somme,  my  Army  doctor  friends  have  assured 
me  that  both  armies  have  found  it  a  matter  of  great 
difficulty  and  watchfulness  to  secure  an  adequate 
supply  of  water  for  the  armies  of  the  first  and  second 
lines. 


DRINKING-WATER  201 

In  some  cases  it  has  been  necessary  to  go  to  the 
trouble  and  expense  of  laying  pipe-lines  from  some 
mountain  lake  or  stream  above  danger  of  con- 
tamination, or  deep  wells,  three  to  six  miles  away, 
just  as  if  one  were  supplying  a  city.  Several  of  the 
sections  of  both  the  English  and  the  Italian  Fronts 
have  been  supplied  in  this  way  and  given  an  abund- 
ance of  pure  cold  water  which  needs  neither  filtering, 
boiling,  nor  chlorinating,  which  is  an  unspeakable 
boon  in  war-time. 

The  majority  of  army  areas,  however,  have  to  draw 
their  supplies  from  some  river  or  lake  or  pond.  Now, 
a  river  is  a  lovely  thing  to  look  at,  "composes"  beau- 
tifully in  a  picture,  is  delightful  to  boat  or  canoe  on, 
refreshing  —  sometimes  —  to  swim  in,  but  to  drink 
out  of — !  Rivers  would  be  all  right  for  drinking- 
water  if  it  were  not  for  the  habit  which  villages  have 
of  coming  down  and  roosting  on  their  banks.  We  have 
all  heard  of  the  pious  citation  in  proof  of  the  bene- 
ficent and  guiding  interest  of  Providence  in  human  af- 
fairs, in  that  great  rivers  always  run  by  large  towns 
even  if  they  have  to  go  miles  out  of  their  way  to  do 
it:  which,  from  a  sanitary  point  of  view,  is  very  nice 
for  the  towns,  but  very  bad  for  the  rivers.  In  short, 
a  running  stream  in  anything  like  a  thickly  settled 
or  civilized  country  is  little  better  than  a  common 
sewer.  And  wells  dug  along  its  banks  or  in  the  bot- 
tom lands  of  its  valley  are  little  better.   It  is  almost 


202  THE  DOCTOR  IN  WAR 

incredible  to  any  one,  who  has  not  made  a  special 
study  of  water-supplies,  how  swift  and  certain  is  this 
contamination  of  wells,  ponds,  and  rivers. 

Our  American  Army  camps  in  the  foothills  and 
plateaus  of  the  Rocky  Mountains  region  used  to  be 
greatly  troubled  with  a  serious  fever  known  as  moun- 
tain fever.  It  had  many  of  the  characteristics  of 
typhoid,  including  a  fairly  high  death-rate,  but  every- 
body scouted  the  idea  of  water-pollution  in  those 
wild,  clean  mountain  ranges.  But  one  or  two  out- 
breaks were  clearly  traced  by  Army  surgeons  of  an 
inquiring  turn  of  mind  to  contamination  by  Indian 
encampments  farther  up;  the  water  was  boiled  or 
chlorinated  and  the  disease  disappeared. 

A  more  modern  instance  was  furnished  in  amusing 
fashion  only  a  few  weeks  ago  on  the  Western  Front. 
A  division  of  our  Allied  troops  was  billeted  in  a  cer- 
tain village.  They  built  their  sinks  and  latrines  ac- 
cording to  sanitary  regulations,  and  ran  them  into 
deep  pits  dug  in  the  soil,  of  the  cesspool  type,  and  to 
discourage  flies  treated  them  daily  with  a  disinfectant 
solution  containing  creosote.  Within  three  or  four 
days  the  village  fathers  waited  upon  the  command- 
ing officer  with  the  bitter  complaint  that  the  creosote 
was  utterly  ruining  the  taste  of  the  drinking-water 
in  their  favorite  wells!  They  had  become  quite  ac- 
customed to  and  unconscious  of  the  taste  of  sewage, 
but  the  flavor  of  creosote  was  more  than  they  could 
stand. 


DRINKING-WATER  203 

While  the  purification  of  water  in  the  field  by 
chlorine  is  simplicity  itself  —  just  dip  up  the  water, 
add  the  chlorine,  shake,  and  allow  to  settle  —  its 
carrying-out  on  any  considerable  scale  in  the  field 
requires  a  little  apparatus.  The  question  of  the 
proper  proportions  of  chlorine  is  readily  met  by  the 
provision  of  boxes  or  cases  of  glass  tubes  each  con- 
taining enough  bleaching  powder  to  sterilize  safely 
five  gallons,  ten  gallons,  or  twenty  gallons  of  water, 
as  may  be  needed. 

Then  comes  the  question  of  a  container  for  the 
water,  for,  although  it  is  quite  possible  to  sterilize 
it  by  the  pitcherful  or  the  bucketful  —  in  fact  gallon 
and  even  quart  tubes  are  provided  for  the  use  of 
travelers  or  small  parties  —  in  camps,  of  course,  it  is 
advisable  to  treat  sufficient  for  a  day's  supply  at  once. 

For  work  in  the  open  field  and  temporary  camps, 
the  container  used  by  the  United  States  Army  is 
simplest,  cheapest,  and  most  easily  portable.  This 
consists  of  a  stout,  waterproof  canvas  bag  capable 
of  holding  thirty  gallons,  with  three  nickel-plated 
spring-action  faucets  opening  from  its  lower  part, 
and  three  stout,  white-metal  rings  set  round  its 
upper  border  or  mouth.  This  is  slung  on  a  tripod  of 
poles  by  cords  from  the  rings,  at  such  a  height  as  to 
bring  the  faucets  about  four  feet  above  the  ground, 
has  a  canvas  flap  or  cover,  and  will  supply  drinking- 
water  for  the  night  and  morning  for  a  hundred  men. 


204  THE  DOCTOR  IN  WAR 

It  takes  only  a  few  minutes  to  fill  and  sling,  and 
thirty  minutes  later  there  is  an  abundant  supply  of 
pure  drinking-water,  without  unpleasant  taste,  in 
an  extremely  accessible  and  convenient  form.  When 
the  bag  is  empty,  it  collapses,  and  can  be  folded  with 
its  ropes  into  a  small,  compact  bundle,  so  that  it  is 
admirably  adapted  for  cavcdry  campaigning  and  one- 
night  camps. 

The  next  simplest  method,  and  the  one  most  com- 
monly in  use  on  the  Italian  and  French  Fronts,  is 
that  of  a  couple  of  large  casks,  or,  where  circum- 
stances permit,  of  specially  constructed  tanks  placed 
side  by  side.  Into  one  of  these  the  raw  water  is 
pumped  from  the  stream  or  pond  or  well,  treated 
with  the  bleaching  powder,  stirred  well,  and  allowed 
to  settle.  When  all  the  sediment  has  subsided,  the 
water  is  siphoned  over  into  the  other  tank  or  cask, 
from  which  it  is  drawn  directly  for  use  or  piped  over 
the  camp. 

Where  it  is  possible  to  use  a  permanent  supply  of 
water  with  a  system  of  distributing-pipes,  the  chlori- 
nation  is  quite  simple;  all  that  is  needed  being  an 
additional  basin  just  before  the  water  goes  into  its 
permanent  storage  or  distribution  reservoir,  in  which 
the  water  can  be  held  for  an  hour  while  the  proper 
proportion  of  bleaching  powder  is  added  to  it. 

Indeed,  it  may  be  of  interest  to  remark  incidentally, 
especially  as  the  fact  is  not  generally  known,  that 


DRINKING-WATER  205 

so  perfect  is  the  protection  afforded  by  bleaching 
powder,  and  so  many  and  incalculable  are  the  dan- 
gers which  threaten  a  great  city's  water-supply,  that 
many  of  our  large  American  cities  —  New  York, 
Chicago,  Cleveland,  and  Toronto,  for  instance  — 
chlorinate  their  water  before  passing  it  into  the  mains. 
So  that  many  who  read  this  know  by  practical  ex- 
perience how  completely  free  from  disagreeable  taste 
properly  chlorinated  water  is. 

It  is  on  the  English  Front  that  the  most  thorough 
and  carefully  thought-out  system  of  water-supply 
for  the  troops  is  in  operation,  though  that  of  some 
sections  of  the  Italian  Front,  which  have  piped  in 
water  from  an  available  mountain  stream,  is  extremely 
good.  In  a  very  considerable  number  of  the  English 
Army  areas,  they  have  either  cleaned  out  and  uti- 
lized old  reservoirs  or  constructed  new  ones,  and  laid 
regular  water-mains  down  behind  their  lines,  with 
branch  pipe-systems  to  supply  the  different  camps. 

Some  of  these  reservoirs  are  filled  by  pumping 
from  a  stream  or  lake,  or  large  marshy  pool  preserved 
for  duck-shooting  purposes,  known  by  the  French 
as  an  **6tang,**  and  then  filtering  and  chlorinating  the 
water.  Some  of  this  water  is  piped  from  quite  a  con- 
siderable distance,  of  which  I  had  a  rather  amusing 
illustration  at  one  point  on  the  English  lines  "some- 
where in  France."  The  Chief  Sanitary  Inspector  for 
the  Army  area,  a  most  enthusiastic  and  competent 


2o6  THE  DOCTOR  IN  WAR 

Staff  officer  who  was  courteously  showing  me  the 
sanitary  arrangements  of  the  zone,  informed  me 
with  a  chuckle  of  natural  pride  that  the  water-supply 
of  something  like  three  divisions  of  the  British  Army 
was  being  drawn  from  a  small  lake  a  mile  or  more 
inside  the  German  lines,  which  was  rather  a  good 
joke  on  Fritz  and  his  wonderful,  superhumanly  om- 
niscient spy  system. 

My  friend  the  Major  said  that  it  only  balanced  up 
matters,  anyway,  because  the  Germans  had  care- 
fully selected  the  high  ground  for  their  trenches  in 
such  a  way  that  they  were  not  only  able  to  drain 
them  completely  without  pumping,  but  to  pour 
their  drainage  into  the  English  trenches  on  the 
lower  ground:  which  was  certainly  adding  insult  to 
injury.  Needless  to  say,  the  water  from  this  conduit 
was  thoroughly  sterilized  and  filtered,  as  well  as 
frequently  examined  for  possible  poisoning. 

Incidentally,  as  a  specimen  of  the  spirit  with  which 
sanitary  measures  are  carried  out  in  the  English 
Army,  this  same  Inspector,  after  a  great  battle  and 
an  advance  of  nearly  three  miles,  had  drinking-water 
piped  on  to  the  battle-field  itself  for  the  use  of  the 
thirsty  troops  within  five  hours  of  the  time  that  they 
had  established  themselves  in  their  new  positions! 
I  strongly  suspect  (though  upon  that  point  I  have  no 
positive  information)  that  he  utilized  this  secret 
conduit  by  tapping  it  higher  up  toward  its  source, 


DRINKING-WATER  207 

but  even  that  would  involve  the  laying  of  something 
like  a  mile  and  a  half  of  pipes  over  an  extremely 
broken  and  irregular  surface,  and  certainly  does  not 
detract  in  any  way  from  the  remarkable  credit  of 
the  performance. 

Where  circumstances  do  not  permit  of  the  install- 
ing of  a  pipe  supply  of  water,  the  English  sanitarians 
have  devised  one  of  the  most  perfect  machines  for 
transforming  any  kind  of  water  into  a  clear,  safe, 
drinkable  beverage  that  I  have  ever  seen.  It  is  based 
upon  the  chlorination  method,  and  consists  of  a  group 
of  tanks  with  an  engine  and  purifying  system  mounted 
upon  a  large  motor  truck.  The  engine  of  the  truck 
provides  the  necessary  power  and  heat. 

The  machine  pumps  its  own  water  from  a  stream 
or  well  or  pond,  drives  it  through  a  mechanical  filter 
under  pressure,  precipitates  it  with  iron  alum,  and 
again  filters  it  under  pressure,  thus  removing  en- 
tirely all  visible  impurities.  Then  it  passes  it  into  a 
large  tank  where  the  chlorine  solution  is  injected  into 
it,  and  after  a  brief  period  of  delay,  the  now  pure,  clear, 
and  absolutely  sterile  water  passes  out  through  the  dis- 
charge pipes,  into  casks,  reservoirs,  or  temporary  pipe- 
lines. By  an  ingenious  arrangement  of  tubes  with  glass 
''windows"  or  eyelets  in  them,  samples  of  the  water 
are  brought  right  under  the  eye  of  the  operating 
engineer  in  the  cab  of  the  motor  at  every  stage  of  the 
process,  and  by  stop-cocks  specimens  are  drawn  off 


2o8  THE  DOCTOR  IN  WAR 

and  tested,  first  chemically  and  at  the  last  bacteri- 
ologically,  so  as  to  see  that  the  process  is  working  to 
perfection  at  every  stage. 

An  equally  ingenious  series  of  stops  and  valves 
gives  the  engineer  perfect  control  of  the  different 
chemical  and  sterilizing  processes,  so  that  he  can  in- 
crease or  diminish  the  amount  of  precipitant  (alum), 
the  pressure  of  the  filter,  and  the  proportion  of 
chlorine,  merely  by  the  pressure  of  a  finger. 

The  result  is  so  absolutely  perfect  as  to  give  one 
almost  an  uncanny  sense  of  magic.  The  first  ma- 
chine which  I  saw  was  doing  a  special  "stunt"  test. 
It  had  dropped  its  intake  pipe  into  a  pool  of  filthy, 
pea-soup-colored,  stagnant  water,  covered  with  green 
scum  which  had  collected  between  two  refuse  heaps 
at  the  back  of  an  abandoned  factory.  From  its  dis- 
charge pipe  was  flowing  into  a  large  tank  a  steady 
stream  of  clear,  sparkling,  nice-tasting  water.  To 
look  at  the  water  in  the  filthy  pool  and  the  clear 
stream  rushing  and  sparkling  into  the  tank,  gave 
one  a  positive  shock. 

The  motor  weighs  about  three  and  a  half  tons, 
travels  by  its  own  power  anywhere,  can  get  under 
way  inside  of  thirty  minutes,  and  can  transform  the 
vilest  soup  into  pure  drinking-water  at  the  rate  of 
about  a  thousand  gallons  an  hour.  That  is  to  say, 
one  machine  is  capable  of  supplying  an  army  of  ten 
thousand  men. 


XII 

GUARDING  THE  HEALTH  OF  OUR  FIRST 
AMERICAN  TROOPS  IN  FRANCE 

A  MORE  quietly  charming  and  peacefully  pictur- 
esque country  than  that  in  which  our  American 
Expeditionary  Force  was  first  temporarily  quartered 
could  hardly  be  imagined:  a  gently  rolling  country 
of  hill  and  valley,  rising  gradually  in  long,  broad- 
crested  waves  to  join  the  western  mountains;  the 
tops  of  the  ridges  for  the  most  part  bare,  thinly 
covered  with  soil  bearing  dwarf  scrub  or  wiry  grass. 

The  towns  and  villages  lie  sheltered  in  the  valleys 
on  the  rich  but  narrow  green  bottom  lands  along  the 
swift  streams.  The  slopes  leading  up  to  the  long,  bare 
hill  ridges,  and  the  deep  little  cross-valleys  running 
down  from  them,  are  clothed  with  woods.  The  effect 
is  quaintly  picturesque  and  ribbon-like,  as  if  some 
skilled  gardener  had  laid  out  the  country  in  broad, 
contrasting  bands:  a  narrow  band  of  bright  green 
down  the  bottoms  of  the  valleys,  picked  out  with  red 
roof  and  gray  wall  and  silver  gleams  of  river;  a  broad 
band  of  dusky  green  of  trees  and  copses  along  the 
slopes;  and  another  band  of  gray  and  silver  green 
along  the  bare  half -alpine  tops  of  the  ridges. 

To  make  the  gay  formal  garden  effect  more  com- 


210  THE  DOCTOR  IN  WAR 

plete,  the  moors  above  are  splashed  with  purple 
streaks  of  heather,  and  the  stubbles  below  are  one 
blush  of  pink,  from  sheets  of  a  magenta-flowered 
mint. 

It  is  a  land  of  sheep  and  cattle  and  bees,  and  closely 
resembles  the  Joan  of  Arc  country.  In  fact,  that  beau- 
tiful pitch  upon  the  shoulder  of  the  hill,  with  the 
wheat-fields  and  pastures  sweeping  away  below  it 
and  the  green  shadows  of  the  woods  behind,  where 
the  Maid  saw  her  first  vision  and  the  memorial  church 
is  built  at  Domremy,  stands  on  the  slopes  of  just 
such  a  valley  as  is  repeated  a  dozen  times  in  our 
America  in  France. 

The  Maid  is  gone,  and  her  visions  have  come  true 
beyond  her  wildest  dreams,  but  her  sheep  still  re- 
main unchanged.  You  can  see  them  being  driven 
down  by  scores  and  hundreds  in  the  sunset  light 
every  evening,  by  the  same  old  sheep  paths  and  wind- 
ing lanes,  from  the  moorland  pastures  above  to  their 
folds  under  the  same  roof  as  their  shepherd  in  the 
village  below.  And  their  shepherds  look  ancient  and 
time-worn  and  primitive  enough  to  have  known 
**La  Pucelle'*  when  she  was  an  infant  in  arms. 

History  repeats  itself  in  a  rather  unexpected  way 
sometimes,  and  our  troops  almost  precisely  duplicate 
the  movements  of  the  Maid  and  her  sheep,  as  they 
march  up  to  the  moorland  levels  every  morning, 
only  to  train  and  drill  instead  of  cropping  grass  and 


OUR  FIRST  TROOPS  IN  FRANCE    211 

seeing  visions.  The  fields  at  the  bottom  of  the  val- 
ley are  too  narrow  and  crowded  and  the  land  too 
valuable  to  be  torn  up  with  trenches  and  covered 
with  barbed- wire  entanglements.  So  most  of  our 
regiments  march  up  the  hill  slopes  for  a  mile  and  a 
half  to  three  miles  every  morning  —  which  is  very 
good  for  their  wind  —  to  their  training  fields  and 
drill  trenches,  which  have  been  laid  out  along  the 
broad,  rolling  summits  of  the  ridges. 

Here  they  march  and  countermarch  and  practice 
complicated  maneuvers  of  attack,  charge  with  the 
bayonet,  jab  viciously  downward  at  dummy  Ger- 
mans in  the  first  trench  as  they  leap  over  it,  and  jump 
fiercely  down  into  the  second  one  and  proceed  to 
"mop  up"  imaginary  Boches.  This,  with  rifle  and 
machine-gun  practice  on  the  ranges,  with  sham  fights 
against  the  splendid  veteran  '*  Chasseurs  a  pied  '*  and 
other  French  troops  which  have  been  sent  down  to 
drill  with  and  against  them,  fills  up  the  time  busily 
until  the  clatter  and  groaning  of  the  chuck  wagons 
scrambling  up  with  their  mule  teams  from  the  valley 
below  announce  the  hour  of  grub. 

Each  man  draws  his  mess- tin  and  dipperful,  and 
the  squads  squat  down  in  long  rows  on  the  ground, 
ofilicers  and  men  alike,  and  fall  to  eagerly.  Then, 
after  twenty  minutes  of  luxurious  basking  with 
slackened  belts,  the  bugles  sound,  up  they  get,  and 
at  it  again  vigorously  for  two  more  hours,  and  then 


212  THE  DOCTOR  IN  WAR 

line  up  for  the  march  downhill  and  into  billets  in  the 
village  below. 

It  is  a  busy,  vigorous,  happy  life  in  the  open  air 
and  the  men  take  to  it  like  ducks  to  water.  And  there 
is  a  good  deal  of  water  for  them  to  take  to,  for  their 
first  ''baptism  of  fire"  was  three  weeks  of  almost  in- 
cessant, chilly,  pelting  autumn  rain,  which  falling  on 
a  clay-loam  soil  gave  them  a  real  foretaste  of  the 
famous  mud  of  the  trenches.  But  this  did  not  stop 
or  dash  them  in  the  slightest  ■ —  they  drilled  and 
marched,  and  charged  with  the  bayonet  and  counter- 
attacked, and  jumped  down  into  trenches  half  full 
of  muddy  water,  all  in  the  pouring  rain,  until  they 
got  so  hard  and  "self-heating"  that  they  positively 
enjoyed  the  downpour  —  or,  at  least,  they  said  so. 

The  men  are  fairly  bursting  the  buttons  off  their 
tunics,  not  below  the  waist,  but  across  the  chest,  and 
not  a  few  of  them  can  actually  hardly  get  into  coats 
which  were  a  comfortable  fit  when  they  joined  the 
Army  three  months  ago.  They  are  getting  as  hard  as 
nails  and  as  waterproof  as  trout.  And  so  splendidly 
are  they  fed  and  so  superbly  sanitated  and  protected 
against  diseases  of  all  sorts,  that  their  sickness  rate 
is  barely  one  and  three  tenths  per  cent,  as  compared 
with  two  and  a  half  in  barracks  in  time  of  peace. 

The  first  and  most  vital  problem  —  that  of  the 
food-supply  —  has  been  solved  by  the  company  or 
double  company  messes  with  their  camp-stoves  and 


OUR  FIRST  TROOPS  IN  FRANCE    213 

semi-underground  ovens  under  the  big  mess-tents 
which  are  pitched  at  convenient  corners  or  open 
spaces  along  the  village  streets,  with  the  mess-tables 
alongside  under  similar  awnings  or  out  in  the  open. 

Many  of  the  men  take  their  mess-tins  and  panni- 
kins full  and  find  seats  for  themselves  on  carts  and 
baskets  and  doorsteps  and  the  platform  in  front  of 
the  Mairie  and  eat  their  rations  picnic-fashion.  This 
forms  a  great  source  of  interest  and  amusement  for  the 
small  fry  of  the  village,  who  have  an  intense  curi- 
osity about  the  new  and  strange  food  of  these  huge, 
friendly,  good-natured  allies  of  theirs,  particularly 
the  corn-syrup  and  the  dried-fruit  pies  and  the  dough- 
nuts and  the  chocolate.  Though  they  tasted  them  in 
fear  and  trembling  at  first,  they  now  highly  approve 
of  these  novelties.  And  although  the  natural  polite- 
ness and  good  manners  of  all  French  children  will  not 
allow  the  older  ones  to  ''hang  round"  at  meal-times, 
except  by  special  invitation  from  personal  friends 
to  whom  they  have  been  properly  introduced,  the 
toddlers  and  three-  and  four-year-olds  have  no  such 
false  delicacy. 

It  is  a  pretty  sight  to  see  a  great  strapping  young 
six-footer  from  Texas,  with  a  plump,  round-eyed 
youngster  perched  on  his  knee,  sampling  eagerly 
each  of  the  successive  "courses."  With  the  older 
children  the  language  question  presents  some  diffi- 
culties, though  they  make  the  very  best  of  teachers, 


214  THE  DOCTOR  IN  WAR 

so  that  that  quickly  disappears,  but  with  the  younger 
ones  the  universal  sign  language  and  lip-reading  are 
quite  sufficient. 

I  was  greatly  amused  by  one  roly-poly  youngster, 
pretty  nearly  as  broad  as  he  was  high,  who  sat  on 
the  pavement,  with  his  short  fat  legs  sticking  straight 
out  in  front  of  him,  right  alongside  of  his  soldier 
friend.  He  did  not  waste  a  single  word  or  sound  or 
motion  while  I  was  watching  him,  but  whenever  he 
needed  a  fresh  supply,  he  simply  tipped  up  his  beak 
and  opened  it  wide,  like  a  young  robin  in  the  nest. 
The  moment  he  was  loaded  he  closed  it  again  and  as 
soon  as  the  gangway  was  cleared,  repeated  the  pro- 
cess, without  the  loss  of  a  moment  or  a  breath. 

Nowhere  upon  all  the  various  fronts  which  I  have 
visited  did  I  find  children  and  soldiers  on  such  friendly 
and  intimate  terms.  In  every  village  that  our  mili- 
tary auto  passed  through  the  children  would  line  up 
and  salute,  and  every  group  that  we  passed  on  the 
road  would  wave  their  hands  to  us  and  seemed  per- 
fectly delighted  when  we  saluted  in  return.  This  is 
due  in  part,  I  think,  to  the  natural  kindliness  and 
fondness  of  children  of  our  American  boys,  and  in  part 
to  their  homesickness.  Grown-ups  may  differ  in  all 
sorts  of  degrees,  language,  dress,  appearance,  behav- 
ior, but  children,  thank  Heaven,  are  alike  the  world 
over,  and  seem  like  a  little  bit  of  home  to  every 
wanderer. 


OUR  FIRST  TROOPS  IN  FRANCE    ^15 

Wherever  you  go  in  the  American  Army  area  — 
whether  you  wear  uniform  or  only  just  look  like 
an  American  — ■  you  are  saluted  on  every  hand  and 
greeted  with  bows  and  smiles  of  the  most  genuine 
friendliness.  They  make  you  feel  that  they  think 
the  mere  fact  that  you  are  an  American  insures  that 
you  are  a  friendly,  generous,  and  trustworthy  sort 
of  person,  and  it  will  be  worth  a  lot  of  trouble  on  our 
part  to  live  up  to  that  reputation.  If  it  had  been 
carried  out  by  orders  from  Headquarters  from  mo- 
tives of  deepest  laid  diplomacy,  it  could  not  have 
been  happier  in  its  results.  The  same  cordial  respect 
and  liking  exists  along  the  English  Front,  but  it  is 
not  shown  quite  so  openly  on  account  of  the  wider 
differences  between  the  French  and  the  English  tem- 
peraments. If  an  Englishman  likes  you,  he  is  more 
than  half  ashamed  to  let  you  suspect  it,  and  nothing 
embarrasses  him  more  keenly  than  any  open  mani- 
festation of  regard  on  your  part.  This  utterly  puzzles 
the  French,  who  were  even  a  little  chilled  at  first  by 
the  triste  and  serious  expression  of  our  American  sol- 
diers. But  it  did  not  take  them  long  to  get  past  that 
barrier,  and  within  a  few  days  they  were  on  the 
very  best  of  terms. 

In  the  language  of  the  day,  our  American  troops 
have  ''made  a  hit,"  and  a  most  emphatic  one,  with 
all  ages,  sexes,  and  sorts  of  the  French  people. 

But  this  picturesque,  picnic  style  of  commissariat 


2i6  THE  DOCTOR  IN  WAR 

for  the  troops  will  not  last  much  longer.  Proper  mov- 
able kitchens,  great  boilers  and  ovens  and  cooking- 
ranges  combined,  mounted  on  wheels  and  drawn  by 
horses  or  motors,  have  been  adopted  by  the  Army 
Board  of  Washington  and  will  be  supplied  to  the 
troops  in  due  time.  These  wheeled  army  kitchens, 
called  by  the  Germans  "  goulash-cannonen "  and  by 
the  French  **  mitrailleuses  k  la  batata,"  are  extremely 
popular  with  the  other  armies,  and  are  the  literal 
cook-shop  on  wheels,  with  balancing  and  anti-splash 
arrangements  which  allow  dinners  to  be  cooked  en 
route  for  regiments  on  the  march.  So  that  whenever 
the  halt  is  called,  the  tired  men  find  piping  hot  stews 
and  potatoes  and  coffee  all  ready  for  them. 

On  the  busy  roads  up  near  the  Front,  when  you 
meet  a  relief  regiment  changing  posts,  after  the  long 
files  of  blue-coated  and  blue-helmeted  "Chasseurs 
k  pied"  or  "Alpins"  have  poured  past,  come  the 
transport  wagons  by  the  score,  piles  of  bedding  and 
blankets  and  kit,  and  then  nobly  protecting  the  rear 
roll  the  great  "goulash-cannonen,"  with  smoke  pour- 
ing out  of  their  chimneys  and  a  most  appetizing 
odor  of  savory  stew  floating  up  from  the  tops  of  their 
cauldrons. 

They  are  the  stomach-warmers  of  the  army,  and 
the  stomach  lies  very  close  to  the  heart.  When  camp 
is  reached,  they  are  halted  in  a  convenient  spot,  a 
ridge-pole   is   run   up   over  them,  a  big  tarpaulin 


OUR  FIRST  TROOPS  IN  FRANCE    217 

stretched  over  that,  and  there  you  have  a  dry,  warm, 
comfortable  kitchen  ready  to  cook  anything  that 
can  be  cooked  in  any  hotel  or  restaurant  in  the  land. 

When  these  have  been  installed  in  the  villages 
and  lumber  to  build  comfortable  mess-halls  secured, 
which  the  men  can  dine  in  during  the  day  and  read 
and  write  letters  and  smoke  in  at  night,  —  for  neither 
lights  nor  smoking  can  be  allowed  in  billets,  —  the 
army  will  be  provisioned  for  any  length  or  kind  of 
campaign. 

The  water  problem  has  been  solved  by  the  use  of  the 
canvas  thirty-gallon  bags  suspended  on  tripods  which 
are  to  be  seen  dotted  about  every  encampment. 
They,  however,  are  only  suited  for  the  autumn 
maneuvers  or  Indian-chasing  style  of  war,  and  will 
soon  be  replaced  by  proper  double  tanks  or  modern 
motor  pumps  and  sterilizers  combined,  of  the  English 
fashion. 

The  bags  are  portable  and  quickly  set  up,  but  for 
permanent  use  they  have  the  very  serious  drawback 
of  having  the  drinking-water  drawn  from  the  same 
vessel  in  which  it  was  chlorinated.  As  there  is  no 
telling  by  the  look  of  the  water  whether  chlorination 
is  complete  or  not,  this  means  that  unless  some  or- 
derly stands  guard  over  the  bag  from  the  time  the 
bleaching  powder  is  put  in  until  the  chlorine  has 
been  completely  neutralized,  the  first  man  who  comes 
up  to  take  a  drink  out  of  it  will  get  a  mouthful  of 


2i8  THE  DOCTOR  IN  WAR 

bleaching  powder  plus  any  dregs  and  sediment  which 
may  have  settled  to  the  bottom  in  the  process. 
Which  gives  him  a  strong  prejudice  against  any  sort 
of  chlorinated  or  otherwise  ''doped"  drinking-water 
for  the  rest  of  that  campaign.  He  will  drink  from  any 
pump  or  well  or  stream  that  he  can  come  across 
sooner  than  resort  again  to  that  ''chemical"  bag. 

While  water  which  has  been  treated  with  bleaching 
powder  is  usually  quite  tasteless  and  good  to  drink, 
in  from  three  quarters  of  an  hour  to  an  hour,  it  is 
much  better  and  safer  to  let  it  stand  overnight.  So 
that  all  permanent  plants  for  the  chlorination  of 
drinking-water  consist  of  two  tanks  or  large  casks 
side  by  side,  in  order  that  the  water  may  be  treated 
and  allowed  to  settle  completely  in  the  one,  and  then 
siphoned  over  into  the  other  for  use,  leaving  six 
inches  of  water  and  all  the  dregs  in  the  bottom  of  the 
first  container. 

Unless  this  is  done,  it  is  difficult  to  get  the  wary 
and  suspicious  dough-boy  into  the  habit  of  drinking 
''bleached  "  water.  Our  Army  medical  officers  are  so 
zealous  and  vigilant  that  they  succeeded  in  making 
the  soldier-boys  take  most  of  their  uncooked  fluid 
nutriment  from  the  bleaching  bags,  as  is  evidenced 
by  the  almost  complete  absence  of  diarrhoea  and 
other  intestinal  disturbances  in  the  camps.  And  as 
nine  tenths  of  all  the  specimens  of  water  from  wells, 
fountains,  or  streams  examined  in  the  zone  have  been 


OUR  FIRST  TROOPS  IN  FRANCE    219 

found  heavily  loaded  with  colon  bacilli,  which  means 
contamination  with  sewage,  this  is  a  real  triumph  for 
their  enthusiasm  and  efficiency. 

But  it  is  a  constant  and  wearing  strain  upon  their 
vigilance,  which  is  unnecessary  and  might  be  en- 
tirely avoided  by  the  installation  of  proper  tanks 
and  pipe-lines  supplying  each  barrack  in  the  camps. 
So  direct  and  striking  is  the  contamination  of  most 
of  the  native  drinking-water  in  the  army  zone,  that 
disinfectants  used  in  our  latrines  give  a  strong  flavor 
of  creosote  within  a  few  days  to  all  the  wells  and 
fountains  in  their  neighborhood. 
{  The  third  great  sanitary  requisite  for  the  health 
of  an  army,  latrines  and  sewage  disposal,  presents 
the  greatest  difficulties  in  the  way  of  its  solution. 
As  none  of  the  villages  occupied  by  our  troops  has  any 
pipe-line  system  of  water-supply,  the  only  methods 
of  waste  disposal  possible  are  by  the  simple  pit  or 
trench  latrines  and  the  running  of  sewage  water  in 
open  ditches  directly  into  the  streams. 

The  soil  of  the  valleys  in  which  the  villages  lie  is 
simply  underlain  with  sheets  of  water,  so  that  wastes 
disposed  of  in  pits  in  the  soil  promptly  find  their 
way  into  all  the  other  deeper  pits  called  wells  within 
a  hundred  or  a  hundred  and  fifty  yards  around  them. 
This  makes  the  pit  or  trench  type  of  latrine  distinctly 
undesirable  from  every  point  of  view. 

The  Sanitary  Corps  of  the  Army  is  keenly  alive 


220  THE  DOCTOR  IN  WAR 

to  the  difficulties  of  the  situation  in  which  it  finds  it- 
self, and  the  pail  and  incinerator  system  of  the  Italian 
and  English  camps  has  been  applied  for  to  the  au- 
thorities and  will  probably  soon  be  granted. 

In  this  method,  the  wastes  in  the  latrines  are 
kept  entirely  above  ground  in  large  pails  containing 
small  quantities  of  disinfectant  fluid.  These  are  emp- 
tied twice  a  day  directly  into  a  special  type  of 
incinerator,  in  which,  by  a  skillful  arrangement  of 
draughts,  they  can  be  burnt  completely  without 
either  smoke  or  odor,  at  an  expense  of  only  about  one 
hundred  pounds  of  coal  per  day  for  each  five  hundred 
men. 

This  is  the  ideal  method  of  camp  sanitation,  for  it 
protects  the  soil  from  any  kind  of  contamination, 
and  what  is  even  more  important  practically,  it  ab- 
solutely prevents  that  busy  middleman  of  the  pes- 
tilences, the  fly,  from  carrying  infection  from  one 
case  to  another.  Every  other  known  system  for  the 
disposal  of  wastes  simply  means  their  reappearance 
in  somebody  else's  food  or  drinking-water  sooner  or 
later.  Pails  and  the  materials  for  building  the  in- 
cinerators have  been  promised,  and  this  admirable 
system  will  doubtless  soon  be  installed  in  our  Army 
camps. 

The  fourth  and  last  great  sanitary  requirement, 
shelter,  has  been  temporarily  solved  in  our  American 
Army  zone  by  the  use  of  billets.  This  means  that  the 


OUR  FIRST  TROOPS  IN  FRANCE    221 

men  are  housed  in  squads  of  from  ten  to  twenty  in 
barns,  haylofts,  granaries,  stables,  the  second  story 
of  hen-roosts,  and  sheep-pens.  After  these  have 
been  thoroughly  cleaned  of  the  dust,  cobwebs,  and 
other  deposits  of  past  centuries,  their  entrances  white- 
washed, and  the  inhabitants  gently  persuaded  to  re- 
move as  many  as  possible  of  their  cows,  horses,  goats, 
sheep,  and  poultry  from  the  ground  floor  of  the  sleep- 
ing-lofts, they  become  fairly  wholesome  and  quite 
tolerable  temporary  accommodation  for  the  use  of 
troops. 

The  thing  that  causes  this  curious  congestion  of 
live-stock  under  the  family  roof,  and  also  makes  it 
very  difficult  to  relieve,  is  that  rural  France  is  still 
constructed  and  organized  on  lines  laid  down  in  the 
tenth  and  twelfth  centuries.  Then  the  forests  were 
full  of  wolves,  and  the  roads  were  infested  by  thieves, 
brigands,  and  members  of  the  nobility,  and  crops, 
live-stock,  or  other  movable  property  left  out  of  doors 
after  dusk  had  about  as  much  chance  of  surviving 
till  morning  as  the  proverbial  snowfiake  in  Hades. 

Consequently  the  French  peasant,  who  has  at 
least  one  of  the  attributes  ascribed  to  his  Bourbon 
kings,  that  he  forgets  nothing,  has  been  so  schooled 
by  tens  of  centuries  of  bitter  experience  that  he  would 
no  more  dream  of  going  to  sleep  at  night  without 
every  one  of  his  precious  animals  under  the  same  roof 
as  himself,  where  he  can  hear  every  noise  they  make 


222  THE  DOCTOR  IN  WAR 

during  the  night  and  go  to  their  assistance,  than  he 
would  of  leaving  one  of  his  children  out  in  the  street. 

This  intimate  and  affectionate  domiciliary  asso- 
ciation has  certain  disadvantages  —  to  the  animals; 
and  one  of  the  bitterest  complaints  of  misbehavior  on 
the  part  of  our  troops,  lodged  with  the  Provost- 
Marshal  in  a  certain  village  in  the  American  zone, 
was  that  of  an  indignant  old  lady  who  came  in  to 
complain  volubly  through  the  interpreter  that  the 
troops  billeted  upon  her  talked  so  loud  and  so  late 
at  night  that  they  kept  her  sheep  and  her  rabbits 
awake! 

So  ingrained  has  this  instinct  become,  of  housing 
all  the  peasant's  belongings  under  the  same  roof  at 
night,  that  when  it  was  politely  and  gently  sug- 
gested by  the  American  ofificers  of  the  day  th^t  the 
furred  and  woolly  and  feathered  pets  should  be 
moved  on  to  the  barns,  they  were  met  by  the  simple, 
staggering  objection  that  there  were  no  barns.  Any- 
thing approaching  that  character  in  the  village  was 
simply  an  annex  of  the  house,  or  the  house  an  an- 
nex of  it,  while  in  the  fields  around  the  village  and 
in  the  open  country  there  was  not  so  much  as  a  shack 
that  would  shelter  a  dozen  chickens. 

This  utter  absence  of  every  kind  and  sort  of 
building  in  the  fields,  outside  of  the  closely  packed 
streets  of  the  villages,  is  what  gives  a  curiously 
half-wild,  prairie-like,  picturesque  appearance  to  the 


OUR  FIRST  TROOPS  IN  FRANCE    223 

French  country.  However,  after  several  conferences, 
out-buildings  and  sheds  of  different  descriptions  as 
remote  as  twenty  or  thirty  yards  from  the  parental 
roof  were  discovered,  to  which  the  dear  creatures 
could  be  temporarily  removed  and  yet  visited  once  or 
twice  during  the  night  in  order  to  keep  them  from 
dying  of  lonesomeness  and  a  sense  of  neglect. 

Another  small  international  complication  that 
arose  was  that  as  soon  as  the  wheat  and  oats  were 
harvested,  the  peasants  of  some  of  the  homesteads  in 
which  our  troops  were  lodged  insisted  upon  filling  all 
the  space  except  that  actually  occupied  by  the  cots 
of  our  men,  up  to  the  roof  with  stacks  and  walls  of 
sheaves.  But  the  O.C.  in  that  village  was  a  bom 
manager  of  men.  He  discovered  in  one  of  the  bams 
a  little  one-horse  threshing-machine,  borrowed  a  horse 
from  the  transport  lines,  and  called  for  volunteers. 
A  dozen  soldier  boys  who  had  been  raised  on  farms 
responded  promptly,  and  in  five  or  six  days'  time  the 
"gang"  made  the  tour  of  the  village  and  threshed 
out  their  whole  small  grain  crop.  This  work  not 
only  made  room  for  their  sleeping  quarters,  but  also 
raised  them  highly  in  the  esteem  of  the  community. 

All  sorts  of  extraordinary  and  unheard-of  accesso- 
ries are  found  necessary  in  modern  war,  but  this  is 
the  first  time  that  a  threshing-machine  has  been 
placed  in  the  list  of  articles  available  for  military 
purposes. 


224  THE  DOCTOR  IN  WAR 

When  cleared  of  their  animal  boarders  and  cleaned 
and  whitewashed,  these  billets  make  dry,  commodious, 
and  well  ventilated,  though  rather  dusty,  quarters 
for  troops  in  summer  and  fall.  They  have,  however, 
the  drawback  that  it  would  be  very  dangerous  to 
have  lights  of  any  description  in  them  at  night,  as 
the  buildings  are  literal  tinder-boxes  which  a  spark 
will  convert  into  a  veritable  fire- trap;  especially  as 
many  of  the  loft  and  haymow  sleeping-places  of  the 
men  are  reached  only  by  rickety  ladders  of  rough 
poles. 

Also,  that  they  are  almost  impossible  to  heat  or 
even  dry  out  in  winter-time,  partly  on  account  of 
their  literally  bam-like  size  and  draughtiness,  partly 
because  many  of  them  have  no  chimneys  passing 
through  or  near  them.  One  energetic  young  regi- 
mental surgeon  had  succeeded  in  partially  solving  this 
last  difficulty  by  refusing  to  accept  any  quarters  for 
billets  in  his  particular  village  which  had  not  a  chim- 
ney running  up  one  or  other  of  their  walls,  into  which 
stove-holes  could  be  cut. 

As  he  had  a  good  village  and  a  small  detachment, 
he  succeeded  in  getting  the  sort  of  quarters  he  wanted 
by  firmly  sticking  to  it,  but  all  billeting  officers  are 
not  so  fortunately  situated  —  nor  so  resourceful  and 
determined. 

It  was  expected  that  before  the  seriously  cold 
weather  sets  in,  supplies  of  lumber  will  have  been 


OUR  FIRST  TROOPS  IN  FRANCE    225 

secured  sufficient  to  build  comfortable  wooden  bar- 
racks with  double  walls,  stoves,  and  real  windows, 
for  the  housing  of  the  troops  after  the  manner  of  the 
French  and  English  camps.  Lumber  is  another  of 
the  peaceful  and  inoffensive  articles  which  has  sud- 
denly found  itself  contraband  of  war  in  this  struggle. 

So  far  has  the  demand  outrun  the  ordinary  supply 
that  both  the  English  and  the  French  Army  au- 
thorities have  found  it  necessary  to  organize  gangs 
of  lumbermen,  picked  out  of  the  troops,  and  supply 
them  with  portable  sawmills  and  set  them  to  work 
in  the  woods  and  forests  in  or  near  the  army  zone. 

The  modern  army  devours  lumber  like  the  locusts 
do  growing  crops,  for  barracks,  for  hospital  wards, 
for  headquarters  and  office  buildings,  for  storage 
sheds,  for  railway  platforms,  for  sidewalks,  for  the 
walls  and  roofs  of  galleries  and  mines,  for  dug-outs 
and  underground  shelters,  for  trench  walls,  and  for 
temporary  roads  over  boggy  places,  corduroy  fashion, 
to  bring  up  the  priceless  guns. 

Gangs  of  lumberjacks  have  already  been  organized 
in  the  American  zone,  and  sawmills  ordered,  and  as 
soon  as  they  arrive  the  ancient  woodlands  of  France 
will  begin  to  suffer,  to  furnish  the  means  to  protect 
her  soil  from  the  invader.  Don  Quixote  went  to  war 
with  windmills,  but  never  since  his  day  has  any 
general  found  it  necessary  to  equip  his  troops  with 
sawmills  and  threshing-machines. 


226  THE  DOCTOR  IN  WAR 

In  the  meantime  our  boys  are  hard  and  brown  and 
vigorous,  and  thanks  to  the  vigilance  and  skill  of 
our  Army  Medical  Corps,  have  a  sickness  rate  which 
is  almost  what  the  French  call  "une  quantity  ne- 
gligeable."  Probably  it  is  just  as  well  for  them  to 
start  from  the  ground,  as  it  were,  begin  with  the 
most  primitive  and  work  their  way  up  from  tents  in 
Texas  to  billets  in  the  training  zone  in  France,  to  the 
full  modem  conveniences  and  sanitary  comforts  of 
twentieth-century  war. 


XIII 

NEW  FACES  FOR.  OLD  AND  MAKING  A 
FRACTION  EQUAL  A  WHOLE 

N^'GT  the  least  wonderful  of  the  triumphs  of  sur- 
gical skill  in  this  war  have  been  won  over 
those  most  dramatic  and  shocking  of  shell  injuries  — 
wounds  of  the  face  and  jaws.  These,  while  perhaps 
not  more  common  than  bullet  wounds  of  the  same 
region  in  former  wars,  have  taken  on  a  far  more  se- 
rious and  ghastly  character  on  account  of  the  great 
size,  jaggedness,  and  terrific  momentum  of  the  shell 
fragments. 

A  bullet  would  go  completely  through  the  face 
from  side  to  side,  and  perhaps  break  one  jaw  or  put 
out  an  eye;  but  a  whizzing,  whirling  boomerang  of 
a  jagged  shell  splinter  disdains  such  feeble  damages 
as  this  and  will  often  shear  away  the  whole  lower  half 
of  the  face,  leaving  the  tongue  hanging  down  on  the 
chest,  or  tear  away  an  eye,  all  the  front  of  the  upper 
jaw  and  teeth,  and  one  side  of  the  lower  jaw  at  one 
swoop. 

The  worst  case  of  all  that  I  saw  was  a  poor  Eng- 
lish boy,  who  had  lost  completely  both  eyes,  his  nose, 
the  front  third  of  his  upper  jaw,  and  about  a  quarter 
of  the  front  of  his  lower  jaw,  including  the  chin  and 


228  THE  DOCTOR  IN  WAR 

lower  lip  and  tip  of  his  tongue.  His  face  when  the 
dressing  was  taken  off  was  just  one  succession  of 
bloody  craters  below  another.  At  first  sight  the  pity 
seemed  to  be  that  he  had  survived  at  all.  But  within 
six  months  that  poor  youngster  had  been  given  new 
fronts  to  both  of  his  jaws  by  bone  grafts,  capable  of 
carrying  full  plates  of  artificial  teeth  so  that  he  could 
chew  perfectly,  a  new  nose,  by  combined  bone  and 
skin  grafts,  and  a  new  lower  lip.  Enough  of  the  eye- 
lids were  left  on  one  side  so  that  by  skillful  repairing 
he  was  able  to  wear  one  glass  eye,  and  a  carefully 
tinted  enamel-coated  metal  plate  held  in  place  by 
a  pair  of  spectacle  frames  completely  covered  the 
gap  in  his  other  orbit.  So  that  his  artificial  face, 
while  far  from  handsome,  was  quite  presentable 
enough  to  allow  him  to  go  about  his  work  and  appear 
on  the  streets  or  anywhere  else  in  public  v/ithout 
attracting  special  attention  or  causing  any  feeling  of 
repulsion  in  those  who  met  him.  The  only  thing  that 
could  not  be  restored  for  the  poor  chap  was  his  sight. 
These  wizard-like  results  have  been  brought  about 
by  a  combination  between  the  dentist  and  the  sur- 
geon, sometimes  in  the  person  of  a  single  individual, 
a  dentist  who  is  also  a  graduate  in  medicine  and  has 
made  a  specialty  of  the  surgery  of  the  face  and  jaws; 
sometimes  by  a  dentist  and  a  surgeon  working  in  co- 
operation; one  doing  the  tooth  and  splint  work  and 
the  other  the  surgery  proper. 


NEW  FACES  FOR  OLD  229 

How  can  the  miracle  of  building  new  faces  in  place 
of  old  ones  be  wrought?  Suppose  that  the  case  is  one 
where  a  part  of  the  upper  jaw  and  most  of  the  nose 
and  upper  lip  have  been  torn  away:  after  the  bleeding 
has  been  stopped,  and  the  worst  of  the  infection  has 
worked  its  way  out  of  the  great  ragged  wound  and 
it  is  beginning  to  show  signs  of  healing,  the  remain- 
ing teeth  in  the  jaw  in  front  of  and  behind  the  gap 
are  tackled  by  the  dentist,  cleaned,  if  necessary  filled, 
and  used  as  the  pillars  for  the  attachment  of  a  curved 
metal  or  wire  splint  bridge  which  temporarily  fills 
in  the  gap.  After  the  tissues  have  become  somewhat 
accustomed  to  this,  it  is  taken  out  and  a  regular  dental 
plate  carrying  the  missing  number  of  teeth  is  fitted 
in  in  its  place. 

This  restores  the  *'bite"  on  that  side  and  the  prob- 
lem of  the  lip  and  side  of  the  nose  is  tackled.  This 
can  be  met  in  several  ways  depending  upon  the  size 
of  the  gap.  If  of  moderate  size,  it  can  be  filled  by 
dissecting  up  a  pear-shaped  patch  of  skin  from  the 
temple  behind  or  from  the  forehead  above,  care- 
fully planned  so  that  the  "stalk"  of  the  pear  con- 
tains the  artery  which  supplies  the  patch  with  blood. 

Then  the  patch  is  twisted  round  on  its  stalk  and 
drawn  down  or  forward  to  cover  the  gap  and  skill- 
fully stitched  into  place  all  round  its  edges.  Having 
still  its  own  blood-supply,  it  keeps  alive  until  it  has 
grown  fast  in  its  new  bed  and  then  the  stalk  of  the 


230  THE  DOCTOR  IN  WAR 

pear  is  cut  across  and  the  transplanting  of  the  flap 
is  complete.  The  gap  left  in  the  skin  of  the  forehead 
or  temple  can  either  be  closed  by  sutures  or  coated 
over  with  skin  grafts. 

If  the  gap  in  the  lip  and  nose  is  too  great,  or,  as 
unfortunately  often  happens,  the  skin  of  the  forehead 
and  temple  has  also  been  badly  gashed  and  damaged, 
then  a  more  radical  and  complicated  method  is  re- 
sorted to.  One  of  the  patient's  arms  is  bent  and  laid 
across  his  face  in  such  a  position  that  the  inner  side 
of  his  forearm  lies  in  contact  with  the  damaged 
side  of  his  face.  It  is  then  bandaged  firmly  in  posi- 
tion, the  hand  being  spread  out  over  the  top  and 
side  of  the  head,  and  a  flap  of  skin  of  the  desired 
size  and  shape  is  dissected  up  from  the  soft,  deli- 
cate inner  side  of  the  forearm.  It  is  twisted  round 
upon  its  stalk,  stitched  into  position,  and  when  it  has 
firmly  taken  root,  the  stalk  is  cut  across  and  stitched 
under  as  before,  and  the  arm  released  from  its  un- 
comfortable position  and  set  at  liberty. 

If  part  of  the  bridge  of  the  nose  and  one  nostril, 
say,  have  been  carried  away,  this  flap  of  skin  will  need 
some  support.  So  an  incision  is  made  under  local 
anaesthesia  over  one  of  the  patient's  ribs,  a  little  strip 
of  bone  just  the  right  size  and  shape  to  fill  the  gap 
in  the  bridge  of  the  nose  is  deftly  sawed  out  of  it 
with  a  tiny  buzz-saw  driven  by  a  dental  engine  slipped 
into  the  bed  prepared  for  it  underneath  the  new  skin 


NEW  FACES  FOR  OLD  231 

of  the  bridge  of  the  nose,  and  behold  the  patient 
has  as  Roman  or  even  aquiline  a  nasal  prominence 
as  he  ever  had  before. 

Such  is  the  indomitable  pluck  of  the  soldier  boys 
that  they  make  all  sorts  of  suggestions  to  their  doc- 
tors as  to  improvements  they  would  like  to  have  made 
in  the  shape  or  height  of  their  noses.  If  they  must 
have  a  new  nose,  they  might  as  well  have  one  to  their 
liking,  instead  of  being  doomed  to  go  back  to  one 
whose  defects  they  may  have  been  sadly  conscious 
of.  They  were  not  consulted  about  the  noses  they 
were  born  with,  but  here  is  their  chance  to  get  one 
that  suits  them. 

If  it  be  part  of  a  lower  jaw  and  chin  which  has  been 
sheared  away,  the  same  methods  of  wiring  or  plate 
splinting  together  of  the  teeth  on  each  side  of  the  gap 
are  followed.  The  lip  and  chin  are  restored  by  flaps 
taken  from  the  cheek  or  neck  or  from  the  forearm 
if  necessary.  But  the  gap  in  the  jaw  needs  further 
attention  because  to  get  a  really  satisfactory  result  it 
should  be  filled  by  bone  if  possible.  So  a  little  socket 
is  cut  with  a  dental  saw  in  the  bone  at  each  end  of 
the  gap,  a  rib  is  cut  down  upon  as  before,  and  a  long 
enough  piece  of  it  carefully  sawed  and  dissected  out 
to  fill  the  gap  in  the  jaw-bone  and  fit  accurately  into 
these  sockets  cut  at  each  end  of  the  gap:  a  long- 
belated  revival  of  the  famous  operation  in  the  Gar- 
den of  Eden,  but  not  so  utterly  surprising,  for  the 


232  THE  DOCTOR  IN  WAR 

Garden  itself  has  been  dragged  into  this  war.  Then 
a  careful  hunt  is  made  for  any  strips  of  periosteum 
which  may  be  left,  the  mucous  membrane  of  the 
mouth  is  laid  open  and  carefully  stitched  with  these 
strips  over  the  piece  of  rib  so  as  to  bury  it  completely. 
With  good  luck  it  will  take  root  in  its  new  position 
and  the  patient  will  again  have  a  good  firm  lower 
jaw  capable  of  moving  all  in  one  piece,  although, 
of  course,  he  will  always  have  to  wear  a  dental  plate 
carrying  teeth  corresponding  to  those  which  have 
been  lost. 

The  main  element  of  "luck'*  in  these  operations, 
either  for  bone  splints  or  other  repairs  of  the  jaws, 
is  the  question  of  infection.  And  curiously  enough, 
while  the  germs  carried  in  on  the  shell  fragments 
are  bad  enough,  the  surgeons  assured  me  that  the 
most  important  single  factor  in  getting  a  good  clean 
heal  without  suppuration  or  breaking  down  was  the 
condition  of  the  patient's  teeth  and  gums  as  to  cavities^ 
abscesses,  etc.,  at  the  time  that  he  was  hit.  A  clean 
mouth  like  a  clear  conscience  is  a  mighty  good  thing 
to  go  into  battle  with. 

One  hardly  knows  which  to  admire  most  highly, 
the  dauntless  pluck  and  cheerful  courage  of  the 
wounded,  who  will  submit  to  operation  after  opera- 
tion not  merely  with  patience,  but  with  enthusiasm, 
in  the  eager  hope  of  getting  rid  of  the  haunting  fear 
that  they  may  be  left  objects  of  repulsion  or  dis- 


NEW  FACES  FOR  OLD  233 

tress  to  their  fellow-men;  or  the  skill,  the  untiring 
devotion,  and  the  painstaking  enthusiasm  of  the  den- 
tists and  surgeons.  No  trouble  is  too  great,  no  pains 
or  ingenuity  too  laborious  to  rescue  these  poor  fel- 
lows from  lifelong  disfigurement.  And  their  persistent 
efforts  are  really  astoundingly  successful  in  the  end. 
One  might  think  from  the  detailed  description  of  the 
gruesome  methods  of  patching,  of  flap  grafting,  and 
bone  grafting  used  that  the  result  would  be  at  best 
a  mere  expressionless  mask  or  a  patchwork  quilt  of 
skin  grafts  with  a  couple  of  smaller  holes  for  nostrils 
and  a  larger  one  for  a  mouth. 

But  nothing  of  the  sort  is  the  case.  The  surgeons 
will  go  the  length  of  a  dozen  operations  with  the  en- 
thusiastic cooperation  of  the  patient  in  order  to 
attain  not  merely  a  workable  mouth,  but  one  which 
is  as  nearly  as  possible  of  the  same  shape  as  the  origi- 
nal one,  taking  particular  pains  with  the  curves  of  the 
angles.  They  have  devised  the  most  ingenious  meth- 
ods of  sewing  together  the  skin  edges  of  the  different 
flaps,  carefully  beveling  off  in  opposite  directions  the 
edges  and  then  burying  their  tiny  sutures  completely 
out  of  sight  under  the  overhanging  of  the  upper 
bevel,  so  that  not  only  no  stitch  marks,  but  no  scar 
is  visible  when  healing  is  complete. 

The  faces  which  they  construct  are  really  thoroughly 
lifelike  and  natural,  though,  of  course,  they  have  a 
slightly  battered  and  "shop-worn"  appearance.  They 


234  THE  DOCTOR  IN  WAR 

go  at  it  In  the  most  workmanlike  and  artistic  style, 
their  first  request  being  that  the  soldier  write  home 
for  a  copy  of  his  latest  photograph  so  that  they  can 
have  a  model  to  work  toward.  There  is  a  story — • 
I  repeat,  a  story  —  told  at  the  Front  about  a  young 
soldier  who  had  had  a  terrific  wound  of  the  face, 
and  who  had  been  patched  up  in  the  most  wonderful 
style.  He  complained  only  that  when  the  surgeons 
wrote  home  for  a  copy  of  his  photograph,  the  family 
made  a  mistake  and  sent  one  of  his  next  younger 
brother;  and  they  had  made  such  a  faithful  copy 
of  their  model  that  he  had  no  end  of  trouble  with 
their  best  friends  always  mistaking  them  for  one 
another,  and  even  their  mother  could  hardly  tell 
them  apart.  But  I  tell  this  simply  as  it  was  told 
to  me. 

In  the  very  worst  cases,  where  the  loss  of  tissue 
has  been  so  tremendous  that  neither  flaps  nor  bone 
grafts  will  fill  the  gap,  another  method  is  followed; 
a  cast  is  taken  of  the  corresponding  parts  on  the 
other  side  of  the  face.  Then  from  this  a  thin  metal 
plate  is  cast  and  coated  with  enamel  accurately 
covering  the  gap  and  matching  the  other  side.  Then 
this  is  most  carefully  painted  and  tinted  by  artists 
who  have  volunteered  for  the  service,  and  attached 
to  a  pair  of  spectacle  frames  which  hold  it  firmly  in 
position.  So  skillfully  and  successfully  is  the  tinting 
and  other  camouflage  done  that  at  a  glance  one  can- 


NEW  FACES  FOR  OLD  235 

not  tell  where  the  edge  of  the  mask  leaves  off  and 
the  living  skin  of  the  face  around  it  begins. 

These  wonderful  masks  are  literally  works  of  art 
in  more  senses  than  one;  some  of  the  best-known 
portrait  and  other  painters  of  both  England  and 
France  having  volunteered  to  produce  them  as  a 
labor  of  love  and  patriotic  service.  If  the  missing 
part  of  the  face  includes  an  orbit,  a  glass  eye  is  in- 
serted in  the  mask,  and  then  lids,  eyelashes,  and  eye- 
brows carefully  painted  round  it.  In  some  cases  to 
make  the  deception  still  more  perfect,  real  hairs  are 
stuck  into  the  enamel  of  the  mask  for  eyelashes  and 
eyebrows. 

Another  new  situation  which  we  had  to  face  in 
this  war  was  a  large  number  of  not  merely  broken, 
but  badly  shattered  bones.  The  decent  and  modest 
round  or  pointed  bullets  of  former  wars  broke  bones 
frequently,  but  often  would  go  completely  through 
a  limb  without  touching  the  bone  at  all,  or  perhaps 
just  splintering  a  chip  off  it,  and  the  wound  left  by 
them  was  a  simple,  rounded  hole  through  the  muscles, 
from  one  side  of  the  limb  to  the  other. 

But  when  a  whirling,  whizzing  fragment  of  shell 
the  size  of  a  stove-lifter  or  of  a  flatiron  strikes  the 
limb,  it  gashes  a  hole  that  you  could  lay  your  whole 
fist  into  through  all  the  muscles  right  down  to  the 
bone  and  shatters  that  into  twenty  fragments,  and 
often  converts  half  the  limb  into  a  mere  mass  of 


236  THE  DOCTOR  IN  WAR 

bloody  pulp.  Every  fracture  in  this  war  is  a  huge 
open  wound,  with  a  not  merely  broken  but  shattered 
and  splintered  bone  at  the  bottom  of  it;  and  what  is 
worse,  the  whole  thing  from  top  to  bottom  reeking 
with  infection. 

The  old-fashioned  wooden  or  moulded  metal  splints, 
which  covered  from  half  to  two  thirds  the  surface  of 
the  limb,  were  hopelessly  unsuited  for  these  cases, 
where  often  nearly  half  the  surface  of  the  limb, 
counting  front  and  back,  was  occupied  by  ragged, 
open  wounds,  on  account  of  the  great  difficulty  of 
dressing  these  wounds,  and  still  more  of  irrigating 
them,  with  the  splints  and  bandages  in  position. 
Even  our  former  sheet  anchor,  a  plaster-of- Paris  cast, 
which  could  be  snugly  applied  to  the  limb,  and  then 
holes,  or  ** windows"  as  they  were  termed,  cut  in  it 
just  over  the  wounds,  so  that  they  could  be  reached 
for  dressing,  failed  to  fill  the  bill,  partly  because  the 
huge  size  of  the  windows  necessary  weakened  the 
cast,  and  partly  on  account  of  the  discharges  or  irri- 
gating fluids  working  their  way  up  and  down  the 
limb  underneath  it. 

So  we  scrapped  these  altogether,  and  took  over 
from  the  orthopedic  surgeons  a  skeleton  splint  which 
had  been  found  of  great  value  in  straightening  the 
limbs  and  healing  the  diseased  joints  of  little  chil- 
dren. This  was  known  as  the  Thomas  splint,  or,  from 
the  American  modification  of  it,  the  Hodgin.   This  is 


NEW  FACES  FOR  OLD  237 

an  extremely  ingenious  and  at  the  same  time  simple 
skeleton  splint,  consisting  roughly  of  a  long  iron  rod 
about  the  size  of  a  lead  pencil,  bent  in  the  middle 
into  the  shape  of  a  huge  hairpin,  about  six  inches 
longer  than  the  limb. 

The  ends  of  the  hairpin  are  socketed  into  a  large 
rounded  wooden  or  hollow  metal  ring  about  an  inch 
and  a  half  in  diameter,  wide  enough  to  slip  com- 
pletely over  the  limb.  This  is  slipped  over  the  foot 
or  head  and  pushed  right  up  till  it  rests  against 
the  body  —  armpit  or  groin  as  the  case  may  be  — • 
in  such  a  position  that  the  rods  lie  one  on  either  side 
of  the  broken  limb  and  the  "bow*'  projects  beyond 
the  foot,  stirrup  fashion.  Then  a  series  of  strips 
of  bandage  are  carried  across  from  one  rod  to  the 
other  underneath  the  limb  and  tied  separately,  so  that 
the  broken  bone  is  supported  on  a  sort  of  banded  ham- 
mock, each  band  of  which  can  be  shortened  or  loosened 
as  may  be  needed  to  make  it  rest  comfortably. 

A  bandage  is  carefully  applied  to  the  ankle  or  wrist 
and  the  ends  of  that  carried  round  the  cross-bar  or 
bow  of  the  hairpin  below  the  hand  or  foot,  then  the 
limb  is  gently  pulled  into  good  position,  the  bandage 
is  tightened  to  hold  it  there,  and  the  wounded  limb, 
thus  held  in  good  position,  is  perfectly  comfortable, 
and  what  is  most  important  of  all,  with  every  inch 
of  its  wounded  surface  accessible  at  five  seconds 
notice  for  dressing  or  treatment. 


238  THE  DOCTOR  IN  WAR 

These  skeleton  splints  are  now  kept  on  hand  in 
every  Advanced  Dressing-Station,  and  even  car- 
ried by  the  stretcher-bearers  out  into  No  Man's 
Land;  so  that  the  shattered  limbs  of  the  wounded 
may  be  "  immobilized  *'  and  kept  comparatively  com- 
fortable on  their  trip  down  to  the  Casualty  Clearing- 
Station. 

2,  At  the  Casualty  Clearing-Station,  there  are  whole 
wards,  and  a  little  farther  back  whole  hospitals, 
which  are  devoted  exclusively  to  the  treatment  of 
fractures,  particularly  of  the  arms  and  legs.  In  these, 
great  wooden  suspension  frames  are  built  up  over 
the  beds  like  a  sort  of  miniature  traveling  crane. 
These  are  most  ingeniously  equipped  with  little,  trav- 
eling carriages,  pulleys  and  weights,  rollers,  and  ad- 
justable derricks,  so  that  the  injured  limb  is  slung 
from  them  and  skillfully  supported  in  the  precise 
position  which  is  best  for  its  healing  and  the  pa- 
tient's comfort.  To  keep  the  limb  from  shortening 
and  the  shattered  fragments  of  bone  from  healing  in 
bad  position,  which  is  one  of  the  greatest  problems 
of  fracture  treatment,  a  sort  of  stirrup  is  carefully 
fastened  to  the  foot  by  means  of  overlapping  strips 
of  rubber  plaster,  or  somxctimes  by  a  sort  of  laced 
or  buttoned  gaiter.  From  this  stirrup  a  cord  is  run 
through  a  pulley  on  the  framework  at  the  foot  of  the 
bed,  and  a  weight  attached  to  the  end  of  it,  care- 
fully adjusted  so  as  to  be  just  heavy  enough  to 


A  FRACTURE  CASE  IN   A  HOSPITAL  ON   THE  WESTERN  FRONT 


NEW  FACES  FOR  OLD  239 

keep  the  limb  stretched  at  the  proper  length  and  in 
good  position  without  fatiguing  or  over-stretching 
the  muscles. 

The  shattered  fragments  of  bone  are  drawn  and 
manipulated  into  good  position  under  ether  with 
the  aid  of  the  X-ray,  and  then  held  there  by  the  ten- 
sion of  springs  or  the  pull  of  weights  over  adjust- 
able pulleys.  Then  the  damaged  parts  of  the  muscles 
are  carefully  cut  away  and  the  ends  stitched  skill- 
fully together.  The  smaller  damaged  arteries  are 
tied,  and  if  the  great  main  artery  of  the  limb  is  torn 
or  even  cut  across  its  walls,  they  can  be  brought 
together  and  stitched  with  fine  catgut  as  neatly  and 
closely  as  a  tailor  will  mend  a  rent  in  a  coat. 

Even  in  such  desperate  conditions  as  the  destruc- 
tion of  an  inch  or  more  of  the  great  main  artery,  a 
carefully  sterilized  tube  is  slipped  into  the  upper 
and  lower  ends  and  tied  in  to  bridge  the  gap  between 
them  for  a  few  days,  until  circulation  can  be  estab- 
lished through  some  of  the  smaller  side  branches 
above  and  below  the  wound,  when  it  is  removed  and 
the  artery  tied. 

The  net  result  of  all  this  patient  and  laborious 
and  painstaking  skill  is  that  out  of  ten  arms  or  legs 
which  would  have  been  considered  helplessly  doomed 
to  amputation  twenty  years  ago,  nine  are  now  saved. 
A  little  weaker  or  stiffer,  or  an  inch  or  so  shorter, 
perhaps,  but  far  superior  to  any  wooden  or  leather  or 


240  THE  DOCTOR  IN  WAR 

steel  and  cork,  or  other  artificial  limb  ever  invented. 
These  fracture  frames  set  up  over  the  beds  are  strong 
enough  to  support  and  sling  up  not  merely  an  arm 
or  a  leg,  but  the  whole  body  as  well  when  necessary, 
as  in  wounds  in  the  back  and  hips,  and  so  perfect 
is  the  control  of  the  position  of  the  limb  by  their 
pulleys  and  cords,  that  even  a  badly  shattered  frac- 
ture of  the  thigh  may  be  healed  with  a  straight  limb 
and  little  or  no  shortening,  in  some  cases  actually 
none  at  all.  Furthermore,  apart  from  this  they  would 
be  worth  all  their  cost  and  care  just  for  the  relief  they 
give  to  the  poor  wounded,  who  after  the  weight  and 
cradles  have  been  properly  adjusted,  and  they  have 
got  accustomed  to  the  new  position  of  the  limb,  can 
move  about  in  bed  and  feed  themselves  and  rest 
comfortably,  and  sleep  as  peacefully  as  children. 

One  devoted  and  enthusiastic  young  surgeon  con- 
fided to  me  that  in  the  beginning,  when  the  appli- 
ance was  new  to  him  and  he  was  most  anxious  to  be 
on  the  safe  side  and  to  prevent  any  shortening,  which 
is  the  rule  in  eight  fractures  out  of  ten,  he  had  ac- 
tually so  thoroughly  straightened  and  stretched  a 
broken  leg  that  it  came  out  slightly  longer  than  the 
sound  one!  But  this  was  a  minor  and  pardonable 
fault,  as  it  only  meant  putting  the  extra  half-inch 
heel  on  the  boot  of  the  souijd  side  instead  of  on  the 
broken  one,  and  the  patient  would  never  know  the 
difference. 


NEW  FACES  FOR  OLD  241 

The  same  enthusiasm  gave  beautiful  results  later, 
as  he  showed  me  in  one  ward  nine  men  with  severe 
fractures  of  the  thigh  who  had  been  less  than  a  week 
out  of  their  slings,  and  who  could  walk  the  length  of 
the  ward  and  back  without  either  a  stick  or  a  limp. 

Nothing  strikes  one  more  forcibly  in  this  war  than 
the  extraordinary  toughness  and  powers  of  adjust- 
ment and  resistance  of  the  human  machine.  One 
scarcely  knows  at  which  to  marvel  most  —  the  way 
in  which  men  who  have  lived  the  sheltered,  peaceful 
humdrum  life  of  modern  civilization  all  their  days, 
never  seen  a  shot  fired  and  scarcely  a  blow  struck 
in  anger,  within  a  few  days  or  weeks  come  to  take 
battle,  murder,  and  sudden  death  as  a  matter  of 
course  and  routine  and  face  the  most  incredible  of 
horrors  and  risks  as  part  of  the  day's  work,  with- 
out turning  a  hair;  or  the  way  in  which  the  most 
frightfully  torn  and  shattered  and  mangled  rem- 
nants of  human  stuff  in  the  hospital,  under  the  pa- 
tient skill  of  the  surgeon  and  the  sleepless  care  of  the 
nurse,  will  pull  themselves  together  again  into  some- 
thing resembling  symmetry  and  the  human  form. 

Luckily  humans  are  not  like  Humpty  Dumpty  — 
they  can  be  "put  together  again,"  without  even  call- 
ing in  "  all  the  King's  horses  and  all  the  King's  men." 
And  the  wonderful  way  in  which  the  disabled  and  the 
crippled  can  be  put  together  again,  and  made,  not. 


242  THE  DOCTOR  IN  WAR 

of  course,  as  good  as  new,  but  skilled,  efficient,  self- 
supporting  workers,  is  one  of  the  medical  triumphs 
of  the  war. 

This  calls  for  a  new  and  special  type  of  hospital, 
not  merely  a  building  with  wards  and  beds  and  an 
operating-room  and  a  staff  of  nurses  and  doctors, 
but  an  establishment  roughly  one  third  hospital,  one 
third  gymnasium  and  massage  rooms,  and  one  third 
manual-training  school.  So  that  directors  of  physi- 
cal training,  masseurs,  and  electro-therapeutists  and 
teachers,  particularly  of  manual-training  schools  and 
polytechnics,  are  as  necessary  and  important  mem- 
bers of  the  staff  as  surgeons  and  nurses.  The  nub  of 
the  problem  and  aim  of  the  whole  establishment  is 
not  so  much  how  well  and  how  symmetrical  a  man 
may  be  made  to  look  again,  but  how  good  a  living  he 
can  be  trained  to  earn  for  himself. 

This  type  of  re-education  hospital  is  particularly 
well  managed  and  carried  out  in  France.  One  famous 
one  in  Paris  is  installed  in  a  great  art  gallery  and 
exhibition  building,  the  same  where  in  happier  times 
are  displayed  every  year  the  pictures  of  the  famed 
French  Salon.  Though  the  patients  are  not  brought 
here  usually  until  six  months  after  they  are  wounded, 
and  their  wounds  are  nearly  closed,  yet  so  jagged  and 
so  horribly  infected  are  the  lacerations  made  by  mod- 
ern shell  fragments  that  it  often  takes  months  and 
even  years  for  them  to  heal  completely  and  soundly. 


NEW  FACES  FOR  OLD  243 

This  period  is  taken  advantage  of,  for  re-educating 
them  for  their  life-work. 

To  everybody's  deHght  it  has  been  found  that  in- 
stead of  delaying  their  recovery  this  actually  hastens 
it  distinctly  and  improves  the  final  results.  Indeed, 
the  modern  ** joint"  surgeon  does  not  hesitate  to  say 
frankly  that  as  much  harm  is  as  often  done  in  the 
way  of  stiffening  joints  and  paralyzing  muscles  by 
keeping  wounded  limbs  too  long  in  badly  shaped 
splints  or  plaster  casts,  as  by  the  original  injury  it- 
self. Get  the  limbs  out  of  their  casts  and  splints  and 
set  their  own  muscles  to  work  as  quickly  as  possible, 
pulling  them  back  into  shape  and  usefulness,  is  their 
motto.  Our  methods  of  treating  fractures  of  bones 
and  injuries  of  joints  have  been  simply  revolution- 
ized already  by  our  experience  in  the  war  and  will 
benefit  thousands  in  future  years  after  this  terrible 
strife  is  ended. 

By  one  of  those  curious  reversals  that  war  so  often 
brings,  the  surgeons  best  fitted  to  treat  these  bearded 
warriors  were  those  who  had  made  a  specialty  of 
straightening  the  limbs  and  restoring  the  joints  and 
bringing  back  the  paralyzed  muscles  of  little  children, 
or  orthopedists  as  they  are  termed.  So  that  the  healer 
of  little  children  has  become  second  only  in  impor- 
tance in  this  war  to  the  general  or  operating  surgeon 
and  great  hospitals  are  being  built  for  him  and  his 
students  all  over  the  warring  countries.    Thus  our 


244  THE  DOCTOR  IN  WAR 

cripples  have  to  "become  as  little  children "  in  order 
to  enter  the  kingdom  of  healing. 

One  of  the  largest  halls  of  the  great  Art  Gallery 
in  Paris  was  turned  into  a  hospital  ward  where  the 
men  slept;  beautifully  light  and  airy,  with  gayly 
frescoed  walls,  but  a  little  bit  difficult  to  heat  in 
winter- time,  it  was  murmured.  The  smaller  halls 
were  occupied  by  a  series  of  work-shops,  some  in 
which  the  patient  himself  was  worked  upon  by  all 
sorts  of  vibrators  and  batteries  and  electric  currents 
and  exercising  machines  of  the  Zander  type,  and  the 
others  in  which  the  patient  worked  upon  the  ma- 
chines and  materials  provided  to  learn  his  new  trade. 

While  he  was  being  massaged  and  shocked  and 
pulled  and  pounded  and  exercised  back  into  shape 
in  the  shops  in  which  he  was  the  raw  material,  the 
strength  of  the  different  groups  of  his  muscles,  and 
the  amount  of  movement  of  which  his  joints  and 
limbs  were  capable,  were  carefully  tested  out  and 
measured.  From  the  results  were  estimated  first  of 
all  what  his  total  strength  was,  whether  he  should 
be  rated  as  quarter-man,  half-man,  or  three-quarter 
man,  so  as  to  place  him  in  the  light,  medium,  or 
heavy-work  class.  Then  the  strength  or  deficiency 
of  the  different  groups  of  his  muscles  was  tested  in 
order  to  find  some  particular  occupation  or  task  in 
which  his  strength  could  be  used  and  his  disabilities 
would  not  interfere.    Then,  after  a  preliminary  try- 


NEW  FACES  FOR  OLD  245 

out  to  see  whether  he  showed  any  aptitude  for  this 
particular  job,  or  whether  something  else  might  fit 
his  natural  tendency  or  previous  training  better,  he 
was  set  to  work  to  learn  his  new  trade. 

There  was  nothing  rigid  or  forced  about  the 
method,  if  the  "mutile"  did  n*t  make  good  progress 
and  take  kindly  to  his  scientifically  selected  trade, 
he  was  tried  out  on  another  one.  In  fact,  the  men 
were  not  infrequently  given  training  in  two  or  more 
trades  which  could  be  carried  on  together  in  villages 
and  little  country  towns  —  such  as  cobbling  and  tool- 
sharpening,  for  instance  —  where  there  might  not  be 
enough  demand  for  either  alone  to  make  a  good 
living. 

In  all  there  were  some  nineteen  or  twenty  differ- 
ent trades  taught,  ranging  from  carpentry,  cobbling, 
metal-work,  and  harness-making  to  photography, 
book-binding,  and  printing. 

The  Director,  who  was  a  doctor  and  physical  di- 
rector of  a  large  college  gymnasium,  was  an  enthu- 
siast and  inspired  his  patients  with  the  same  spirit. 
It  was  a  pleasure  to  see  the  enthusiasm  and  energy 
with  which  they  went  about  the  work  of  overcoming 
their  defects.  Thanks  partly  to  the  universal  use  of 
machinery  in  modern  industry,  so  that  great  mus- 
cular strength  is  no  longer  necessary,  partly  to  his 
devoted  skill  in  fitting  the  disabled  man  to  the  par- 
ticular task  which  suited  him,  the  doctor  assured 


246  THE  DOCTOR  IN  WAR 

me  that,  somewhat  to  his  own  surprise  even,  he  was 
able  to  make  more  than  two  thirds  of  his  patients 
*'full  hands"  at  some  particular  trade. 

Then  he  brought  his  infectious  enthusiasm  to  bear 
upon  the  employers  and  brought  them  to  see  that  so 
long  as  a  man  did  full  work  they  must  pay  him  full 
wages,  regardless  of  how  much  of  him  might  be  miss- 
ing: with  the  gratifying  practical  result  that  not  one 
of  his  graduates  was  earning  less  than  eight  francs 
a  day,  which  was  very  good  wages  at  French  rates, 
the  equivalent  of  nearly  four  dollars  a  day,  Ameri- 
can standard ;  men  after  training  earned  more. 

As  something  like  two  thirds  of  the  population  of 
France  is  peasant,  special  attention  was  given  to 
** little"  trades,  like  cobbling,  harness-making,  tool- 
grinding,  tailoring,  etc.,  such  as  could  be  carried  on 
in  small  villages.  And  in  addition  there  was  a  spe- 
cial branch  afhliated  with  the  hospital,  a  farm  school 
out  in  the  country,  where  the  cripples  who  wished 
to  go  back  to  the  soil  could  receive  special  training 
in  modern  methods  of  farming,  particularly  garden- 
ing, dairying,  and  what  the  French  call  '*la  petite 
culture";  that  is,  poultry,  rabbits,  bees,  etc.  This 
school  is  situated  on  a  beautiful  old  French  farm, 
about  ten  miles  from  Paris,  close  to  a  large  military 
hospital,  where  the  pupils  live  and  receive  such  medi- 
cal care  as  they  need  during  their  course. 
^  Happily  the  number  of  these  hospital  schools  re- 


NEW  FACES  FOR  OLD  247 

quired  will  be  smaller  in  proportion  than  in  any  pre- 
vious war,  on  account  of  the  splendidly  successful 
way  in  which  the  Hospitals  at  the  Front  have  done 
their  work.  So  far  it  is  estimated  that  the  cripples 
and  severely  disabled  men  are  about  one  tenth  of  the 
men  killed,  —  that  is  to  say,  from  two  to  five  per 
cent  of  the  wounded,  ■ —  but  there  will  be  enough  at 
the  best,  Heaven  help  us ! 

After  visiting  France  one  is  frequently  asked 
whether  the  eye  is  not  perpetually  saddened  every- 
where, on  the  streets  and  in  the  trains  by  the  sight 
of  pitiable  cripples  —  armless,  legless,  blinded,  and 
otherwise  terribly  mutilated  victims  of  the  war? 
The  answer  is,  not  to  anything  like  the  extent  which 
one  would  have  expected,  partly  because  the  surgery 
has  been  so  skillful  and  successful,  partly  because 
the  crippled  soldiers,  instead  of  being  sent  home  or 
turned  out  to  shift  for  themselves,  are  splendidly 
taken  care  of  in  these  great  re-educational  establish- 
ments until  they  can  be  fitted  to  a  new  niche  in  life. 
Finally,  because,  when  their  re-education  is  completed, 
their  shattered  joints  limbered  up,  their  new  arms 
and  legs  carefully  fitted  in  the  best  modern  style, 
they  are  able  to  go  about  their  work  so  briskly  and 
confidently  that  in  their  street  clothing  the  average 
eye  would  hardly  recognize  them  as  cripples. 


XIV 

THE  NEW  DISEASES  OF  THE  WAR 

THIS  war,  though  it  has  introduced  many  new 
and  unexpected  situations,  has  added  little 
that  could  be  really  termed  original,  not  even  in  the 
realm  of  disease.  Only  three  diseases  have  appeared 
in  four  years  of  it  which  could  really  be  termed  new, 
and  these  all  bear  the  name  of  its  most  striking  fea- 
ture, Trench  Fever,  Trench  Nephritis,  and  Trench 
Feet.  These  are  comparatively  mild  diseases,  not  to 
be  compared  in  either  dangerousness  or  frequency 
with  typhoid,  diarrhoea,  or  dysentery  in  the  old  days, 
and  seldom  prove  fatal.  But  they  are  severe  enough 
to  disable  a  soldier  and  common  enough  to  be  annoy- 
ing, and  what  makes  them  particularly  exasperating 
is  that  after  years  of  laboratory  research  we  are  still 
in  the  dark  as  to  the  cause  of  the  last  two  and  only 
partially  enlightened  as  to  the  first. 

Trench  fever  is  a  curious  relapsing  fever  something 
like  a  mild  form  of  malaria.  The  patient  comes  down 
with  a  sharp  rise  of  temperature,  and  pains  in  his  back 
and  limbs,  then  after  four  or  five  days  of  fever  he  im- 
proves and  seems  to  be  getting  better,  and  suddenly, 
without  any  apparent  cause,  up  goes  his  tempera- 
ture again,  and  so  the  process  repeats  itself  for  Jour 


NEW  DISEASES  OF  THE  WAR    249 

or  five  weeks.  He  is  never  very  seriously  ill  and  usu- 
ally recovers  completely  when  he  is  sent  back  to  the 
Base  or  to  England,  but  he  is  "off  the  strength" 
for  a  considerable  time  and  is  rather  apt  to  break 
down  again  with  another  attack  after  he  comes  back 
to  duty. 

Though  a  number  of  organisms  have  been  accused 
and  ** shadowed,"  the  criminal  one  has  not  yet  been 
discovered,  but  there  has  been  a  growing  consensus 
of  opinion  that  the  disease  is  due  to  an  infection  car- 
ried by  the  bite  of  the  louse,  supported  by  the  fact 
that  the  disease  is  becoming  distinctly  less  common 
as  the  trenches  are  better  drained  and  sanitated,  and 
the  men  well  supplied  with  hot  shower  baths  and  clean 
underwear. 

Indeed,  within  the  last  few  months,  the  problem 
has  been  definitely  and  successfully  attacked  by  the 
ever-victorious  method  of  direct  experimentation 
upon  human  volunteers.  Groups  of  soldiers,  chiefly 
from  the  Medical  and  Sanitary  Corps,  volunteered 
for  this  splendid  service  to  humanity,  first  in  the 
English  and  Canadian  and  then  in  our  American 
army  hospitals,  with  the  result  of  conclusively  prov- 
ing that  trench  fever,  like  typhus,  was  transmitted 
by  the  bite  of  the  body  louse,  now  enjoying  a  wide 
notoriety,  if  not  favorable  reputation,  under  the 
name  of  "cootie." 

Insects  which  have  been  living  upon  men  known 


250  THE  DOCTOR  IN  WAR 

to  be  infected  with  trench  fever  were  transferred  to 
the  bodies  of  healthy  men,  but  the  first  results  were 
somewhat  puzzling,  inasmuch  as  while  infection  did 
sometimes  take  place,  this  was  only  in  a  small  propor- 
tion of  cases,  and  in  some  groups  the  result  of  lice 
transference  was  almost  entirely  negative.  ;  -/•     • 

What  made  this  the  more  puzzling  was,  that  the 
disease  could  be  surely  and  promptly  transmitted  by 
inoculating  healthy  men  with  the  blood  of  those  suf- 
fering from  it.  There  must  be  some  third  factor  at 
work,  and  this  turned  out  to  be  a  rather  unexpected, 
and  to  say  the  least  of  it,  a  rather  distinctly  unsesthetic 
and  undignified  one.  It  suddenly  occurred  to  one  of 
the  younger  doctors  that  the  men  who  were  volun- 
tarily undergoing  this  experiment  were  bearing  the 
discomfort  of  their  infestation  in  the  most  Spartan 
fashion,  and  were  scarcely  scratching  themselves  at 
all.  On  inquiry  he  quickly  found  that  having  sub- 
mitted themselves  for  this  serious  and  most  important 
experiment,  they  considered  that  it  was  beneath 
their  dignity  to  scratch,  and  also  that  it  might  per- 
haps interfere  with  the  success  of  the  experiment 
and  the  accuracy  of  the  result. 

A  suspicion  dawned  in  the  young  man's  mind  that 
perhaps  their  stem  and  stoic  self-restraint  might  have 
produced  just  the  opposite  effect  from  what  was  in- 
tended, and  he  thereupon  gave  them  free  leave  and 
license  to  excoriate  their  itching  surfaces  as  heartily 


NEW  DISEASES  OF  THE  WAR    251 

as  they  wished.  The  result  was  that  every  one  of  the 
squad  developed  a  beautiful  case  of  the  disease  within 
four  or  five  days. 

The  secret  of  the  disease  was  discovered.  The 
pestilent  insect  unquestionably  infected  itself  through 
the  blood  which  it  drew  from  the  patient,  but  appar- 
ently only  occasionally  secreted  the  germ  through 
the  glands  of  its  mouth  parts,  as  the  mosquito,  for 
instance,  does  the  malaria  germ,  so  that  it  was  only 
occasionally  that  its  new  host  would  be  infected  by 
its  bite.  But  if  the  whole  body  of  the  louse  was 
crushed  upon  the  surface  of  the  skin  and  then  rubbed 
into  the  tiny  abrasions  produced  by  scratching,  the 
germs  in  its  body  would  be  certainly  absorbed  into 
the  new  patient's  blood.  It  also  appeared  that  the 
excreta  of  the  lice  contained  the  germs  of  the  disease, 
and  that  these,  when  deposited  upon  the  skin  and 
scratched  in,  would  infect  the  new  host. 

Again,  as  often  happens,  duty  and  pleasure  do  not 
run  hand  in  hand,  and  the  best  cure  for  the  itch  is 
not,  as  the  old  pessimistic  proverb  used  to  have  it, 
*'to  scratch,"  to  say  nothing  of  avoiding  trench  fever. 

So  that  by  the  free  use  of  the  hot  shower  bath  for 
the  bodies  of  the  men  and  the  steam  sterilizer  for 
their  clothing,  in  the  now  famous  and  unspeakably 
beneficial  "debusing"  or  ''unlousing"  establishments 
described  in  the  chapter  '*  Mountains  and  Medicine," 
not  only  will   this  distressing  disease  be  stamj^cd 


252  THE  DOCTOR  IN  WAR 

out,  but  the  Army  will  be  relieved  from  one  of  the 
most  annoying  and  exasperating  of  its  discomforts. 
Great  progress  has  already  been  made  in  this  latter 
direction  already,  and  it  would  be  safe  to  say  that 
infestation  with  ''cooties'*  has  become  the  exception 
instead  of  the  rule  in  our  armies.  And  with  this 
added  incentive  to  push  to  its  utmost  limit  the  fight 
against  these  wretched  little  pests,  of  stamping  out 
trench  fever,  which  was  estimated  at  one  time  to  keep 
nearly  five  per  cent  of  the  Army  in  the  field  more  or 
less  constantly  on  the  sick  list,  the  plague  will  ere 
long  be  stamped  out  altogether. 

Trench  nephritis,  as  its  name  implies,  is  a  slow 
inflammation  of  the  kidneys  with  albumen  in  the 
urine,  a  sort  of  mild  and  curable  form  of  Bright's 
Disease.  Like  trench  fever  it  runs  a  slow  and  irregu- 
lar course  and  usually  ends  in  recovery  —  indeed, 
the  few  cases  which  do  not  are  mainly  those  in  which 
there  is  reason  to  believe  that  some  chronic  disease 
of  the  kidney  had  existed  before  the  attack. 

Various  causes  are  suggested  for  trench  nephritis 
—  the  terrific  exposures  to  wet  and  cold  and  mud  in 
the  trenches,  germs  from  the  trench  mud,  sudden 
strains  as  of  emergency  marches  under  heavy  packs 
falling  upon  men  of  indoor  occupations  and  trades, 
irregularities  of  diet,  etc.  —  but  none  of  them  have 
been  definitely  proven.  The  weight  of  opinion  is 
rather  in  favor  of  the  view  that  all  these  play  their 


NEW  DISEASES  OF  THE  WAR    253 

part  and  that  the  disease  is  not  due  to  a  germ,  which 
is  rather  supported  by  the  fact  that  it  is  most  com- 
mon in  winter,  and  that  a  battle  or  extensive  chang- 
ing of  lines,  with  long,  exhausting  marches,  is  often 
followed  by  a  fresh  crop  of  cases. 

It  is  significant  that  in  these  alternations  of  violent 
activity  with  comparative  stagnation,  the  natural 
food  relations  are  reversed,  the  rations  being  some- 
what scantier,  drier,  and  less  attractive  on  route 
marches  and  in  the  front-line  trenches,  and  very 
abundant  and  attractive  in  the  rest-camps  and  under- 
ground galleries  in  support  behind  the  third-line 
trenches. 

At  all  events,  strong  and  successful  efforts  are 
being  made  to  equalize  and  balance  up  between  the 
alternations,  both  of  extremes  of  activity  and  of 
food,  so  far  as  the  stern  necessities  of  war  will  permit; 
sending  up  at  great  risk  to  life  regular  supplies  of  hot 
food  to  the  front-line  trenches  and  cutting  down 
upon  wastefully  abundant  rations  in  the  rest-camps, 
while  pack  drills  and  practice  marches  are  kept  more 
within  the  limits  of  endurance  of  the  less  sturdy  men, 
and  the  amount  of  active  exercise  and  even  light 
labor  in  the  rest- camps  increased  —  considerably 
more,  in  fact,  of  the  latter  than  Mr.  Thomas  Atkins 
or  Jacques  Poilu  appreciates  with  any  cordiality. 
And  the  disease,  whether  in  consequence  or  as  a 
coincidence,  is  distinctly  diminishing  in  both  severity 


254  THE  DOCTOR  IN  WAR 

and  frequency  as  these  and  other  health  conditions 
are  more  carefully  studied  and  adjusted. 

When  the  full  misery  and  hardship  of  trench  war- 
fare in  snow  and  sleet  and  bottomless  mud  began  to 
dawn  upon  us  in  the  gloomy  winter  of  19 14,  one  of 
the  torments  that  stood  out  first  and  most  promi- 
nently  was  a  painful  and  peculiar  inflammation  of 
the  feet,  ankles,  and  legs,  dubbed  by  the  soldiers 
"trench  feet.'*  It  looked  and  behaved  like  a  cross 
between  chilblains  and  frozen  feet.  The  feet  would 
first  swell  and  turn  dull  red  and  purplish;  then  the 
skin  would  begin  to  itch  and  burn  intolerably ;  then, 
if  bathing  and  antiseptics  did  not  check  the  process, 
little  blisters  and  pustules  would  rise  up  all  over  the 
surface,  the  purple  color  would  deepen  to  bluish 
black,  and  a  superficial  gangrene  of  the  top  of  the 
foot  and  toes  and  occasionally  the  soles  would  be- 
gin to  set  in.  So  severe  was  the  gangrene  that  large 
patches  of  the  skin  and  surface  of  the  feet  would  die 
and  slough  away  completely,  while  in  the  worst  forms 
it  would  look  as  if  an  amputation  would  have  to  be 
done  in  order  to  prevent  the  absorption  of  the  poisons 
of  decay  into  the  system. 

It  was  an  extremely  obstinate,  painful  disease,  and 
while  as  a  rule  it  could  be  checked  with  little  worse 
than  the  sloughing  and  ulcerating  away  of  a  few 
patches  of  skin,  it  threatened  to  become  serious  from 
a  military  point  of  view,  for  it  was  almost  totally 


NEW  DISEASES  OF  THE  WAR    255 

disabling  while  it  lasted,  and  at  one  time  was  so  com- 
mon that  it  was  estimated  that  nearly  ten  per  cent 
of  the  soldiers  in  Flanders  and  Northern  France,  on 
both  sides  of  the  fighting  line,  were  constantly  laid  up 
by  it.  In  fact,  it  became  so  troublesome  that  a  special 
commission  was  appointed  to  inquire  into  its  causa- 
tion and  see  what  could  be  done  to  prevent  it. 

Because  the  disease  first  began  in  winter,  when  the 
men  were  complaining  bitterly  of  the  cold  and  also 
because  it  started  like  an  attack  of  chilblains  and 
ended  like  a  bad  case  of  frost-bite,  it  was  supposed 
that  extreme  cold  combined  with  wet  was  an  im- 
portant factor  in  causing  it.  But  it  was  quickly  found 
that  although  the  cold  undoubtedly  aggravated  and 
hastened  the  process,  as  a  matter  of  fact  the  mud  and 
the  water  in  the  trenches  were  almost  never  frozen, 
so  that  the  men*s  feet  were  seldom  exposed  to  a  tem- 
perature below  freezing :  certainly  not  enough  to  pro- 
duce genuine  frost-bite,  or  anything  approaching  it. 

Moreover,  the  disease  showed  no  special  tendency 
to  diminish  with  the  coming  of  the  warmer  weather 
in  the  spring,  except  where  special  measures  had  been 
taken  against  it.  I  was  much  interested  to  discover, 
on  my  visit  to  the  Italian  Front,  that  during  the  first 
year  of  their  trench  warfare,  their  soldiers  had  suffered 
very  severely  and  extensively  from  trench  feet,  al- 
though such  a  thing  as  a  frost  is  rare  along  the  Isonzo. 
In  fact,  Gorizia,  Gradisca,  and  Monfalcone  are  all 


256  THE  DOCTOR  IN  WAR 

celebrated  as  winter  health  resorts.  But  they  had 
plenty  of  the  two  real  causes  of  the  disease :  undrained 
trenches  and  infected  mud. 

The  first  thing  discovered  that  pointed  in  the 
direction  of  relief  was  that  pressure  of  both  boots 
and  leggings  had  a  good  deal  to  do  with  the  produc- 
tion of  the  disease.  The  army  boots  were  fairly  com-  ' 
fortable  and  loose-fitting,  but  the  soldiers,  knowing 
that  they  would  often  be  standing  up  to  their  ankles 
or  to  their  knees  or  even  waists  in  thin  mud  or  water, 
naturally  were  inclined  to  lace  up  their  boots  as 
tightly  as  possible,  so  as  to  keep  them  from  leaking 
from  above.  This  seriously  interfered  with  the  return 
circulation  of  the  blood  in  the  feet  and  started  them 
to  swelling,  which,  of  course,  raised  the  pressure  still 
higher  and  set  up  a  regular  **  vicious  circle." 

Boots  at  least  two  sizes  too  big  for  ordinary  wear 
or  marching  purposes  were  issued  to  the  men,  and 
they  were  instructed  to  wear  heavy  woolen  socks 
and  to  avoid  lacing  their  boot-tops  too  tightly.  But 
the  more  serious  binding  was  found  to  be  due  to 
the  puttees  and  leggings  worn  by  the  men,  and  of 
the  two,  most  unexpectedly,  the  puttees  were  the 
worst. 

This  was  due  to  the  fact  that  in  order  to  hold  in 
place  and  present  a  trim  and  soldierly  appearance,  it 
was  necessary  to  wind  these  curious  woolen  leg- 
bandages  so  tightly  that  the  big  surface  veins  of  the 


NEW  DISEASES  OF  THE  WAR    257 

legs  were  severely  pressed  upon,  making  the  feet  first 
swollen  and  then  cold. 

New  methods  of  winding  them  round  the  legs  were 
devised,  after  the  fashion  of  what  is  known  as  a 
*'spica"  bandage  in  surgery,  which  would  enable 
them  to  cling  to  the  leg  and  yet  not  grip  it  too 
closely,  and  by  means  of  this,  with  the  looser  shoes 
and  double  socks,  the  amount  and  severity  of  the 
disease  were  considerably  reduced. 

Still  it  continued  troublesome,  until  the  idea  finally 
took  shape  that  the  real,  underlying  cause  of  the 
plague  was  neither  wet  nor  cold  nor  tight  foot-wear, 
but  slow  infection  of  the  skin  from  constant  soaking 
in  the  foul,  infected  mud  of  the  trenches. 

This  was  attacked  in  two  ways:  By  installing  a 
regular  system  of  motor-driven  pumps  to  empty  out 
the  low  spots,  or  specially  constructed  drainage  pits 
and  basins  in  the  saps  of  the  trenches.  Another  way 
was  the  extension  of  a  complete  system  of  the  blessed 
duck-walks  or  wooden  grating  sidewalks  which  are 
elsewhere  described. 

But  the  finishing  touch  in  the  conquest  of  the 
plague  was  put,  I  am  happy  to  say,  by  another 
American  invention,  and  that  was  the  good,  old- 
fashioned  hip  rubber  boots  of  our  happy  boyhood 
days  in  the  duck-swamps  and  the  trout-streams. 
Duck-boards  and  duck-boots  together  were  the  win- 
ning combination. 


258  THE  DOCTOR  IN  WAR 

I  found  along  the  English  Front  in  Flanders,  at 
the  Battalion  Headquarters  of  each  section  of  low- 
lying  trench,  hundreds  of  pairs  of  high  rubber  boots 
which  were  issued  to  the  men  as  they  went  on  duty 
for  their  three  days'  turn  in  the  front  trenches. 
With  real  English  thoroughness  there  was  also  a 
special  drying-chamber,  to  which  the  boots  were 
promptly  taken  as  the  men  turned  them  in  on  their 
return  from  duty,  where  they  were  dried  and  warmed 
on  special  racks,  so  as  to  be  in  good  condition  for 
issuance  to  the  ingoing  squad  next  day.  These,  with 
plenty  of  thick  woolen  socks  inside,  are  an  almost 
perfect  preventive  and  protection  against  trench  feet. 

One  other  element,  however,  was  found  to  be  quite 
important,  although  it  sounds  at  first  sight  rather 
trivial,  and  that  was  thorough  and  scrupulous  clean- 
liness of  the  men's  feet  and  frequent  changing  of  their 
socks. 

One  cheerful  young  subaltern,  whom  I  met  on  a 
train,  who  did  not  know  I  was  a  doctor,  was  good- 
naturedly  grumbling  at  the  dreadful  amount  of  what 
he  called  "nursemaid  work"  which  an  officer  was 
nowadays  required  to  do  for  his  men.  *'Why,  you 
know,"  he  said,  ''these  doctor  johnnies  have  got  such 
a  lot  of  fussy  regulations  passed  that  I  actually  have 
to  see,  not  only  that  my  lot  get  clean  underwear  and 
clean  socks  twice  a  week,  but  that  they  put  'em  on, 
and  if  they  have  n't  got  'em  on  when  inspection 


NEW  DISEASES  OF  THE  WAR    259 

comes,  I  get  a  wigging.  I  Ve  got  to  go  round  every 
night  and  see  that  they  have  greased  their  little  feet 
and  washed  their  pretty  pink  toeses  before  they  go 
to  bed.  But  I  'm  bound  to  say  that  the  beggars  keep 
as  fit  as  fighting  cocks  with  it  all." 

Greasing  the  feet  and  legs  with  whale-oil  or  other 
thick  tenacious  grease  and  keeping  the  men  moving 
and  stamping  about  in  the  trenches,  so  as  to  keep 
up  good  circulation  in  their  feet,  were  found  also 
helpful. 

The  same  method  applied  to  the  trench  feet  in  the 
Italian  Army  produced  an  almost  complete  clean-up 
of  the  condition. 

Now  that  trench  warfare  has  been  reduced  to  a 
science,  new  intrenchments  are  dug  and  planned  with 
special  reference  to  drainage  as  well  as  to  defense. 
Rain  and  earth  mixed  together  make  mud,  but  they 
have  to  be  churned  and  kneaded  into  each  other  to 
develop  any  considerable  degree  of  either  depth  or 
gumminess.  If  anything  like  a  reasonable  slope  for 
the  drainage  of  rain  and  storm  water  is  provided, 
even  the  clayeyest  and  stickiest  of  soils  will  "shed" 
two  thirds  to  three  fourths  of  the  water  that  falls  on 
it  before  it  has  time  to  be  kneaded  into  paste.  So 
that  with  scrupulous  cleanliness,  loose,  warm  foot 
and  leg  wear,  and  reasonably  drained  and  grated 
trenches,  the  soldier  who  now  enters  the  line  of  battle 
need  have  little  fear  of  trouble  from  trench  feet. 


26o  THE  DOCTOR  IN  WAR 

The  disease  has  diminished  in  a  most  rapid  and 
gratifying  manner  and  such  cases  of  it  as  now  occur 
come  chiefly  after  a  long  offensive  like  those  of  last 
autumn  when  men  have  gone  forward  from  the 
trenches  altogether  and  been  obliged  to  hold  posi- 
tions consisting  simply  of  shell-holes  half-full  of  mud 
and  water  for  days  at  a  stretch.  When  visiting  the 
Front  in  Flanders  in  April  last  year  I  had  hard  work 
to  find  a  well-marked  typical  case  of  trench  feet,  but 
on  returning  in  October,  after  the  capture  of  the 
ridges,  I  saw  quite  a  considerable  sprinkling  of  cases 
from  shell-hole  conditions  of  this  sort,  but  they  were 
fortunately  of  rather  a  mild  type  and  all  rapidly 
recovering. 

One  decidedly  interesting  and  consoling  fact 
strikes  one  very  forcibly  all  along  the  battle-line,  and 
that  is  that  in  spite  of  the  most  terrific  and  constant 
exposures  to  cold  and  wet  and  mud,  in  the  most  abom- 
inable of  weathers  there  has  been  extraordinarily  lit- 
tle rheumatism,  or  gout,  or  neuritis  of  any  sort.  This 
is  the  more  striking  because  the  troops  have  in  addi- 
tion been  exposed  in  a  very  high  degree  to  the  other 
supposed  cause  of  rheumatism,  red  meat  and  uric 
acid  in  all  its  forms.  The  men  have  had  practically 
all  the  meat  that  they  could  eat  and  all  the  tea  or 
coffee  they  could  drink  twice  and  sometimes  three 
times  a  day  —  not  merely  for  months,  but  for  years, 
and  yet  gout,  rheumatism,  and  arterio-sclerosis  are 


NEW  DISEASES  OF  THE  WAR     261 

conspicuous  by  their  absence.  A  more  complete  and 
overwhelming  explosion  of  the  vegetarian  delusion 
and  the  uric  acid  myth  could  hardly  have  been 
imagined. 


XV 

KEEPING  THE  CAMPS  HEALTHY 

N"  EXT  after  putting  a  roof  of  some  sort  over  the 
soldier  man,  and  walls  round  him  to  enclose  a 
small  slice  of  the  universe,  cut  out  of  the  wide,  wide 
world,  which  could  be  heated  and  dried  at  pleasure, 
comes  the  question  of  keeping  him  dry  under  foot. 
Or,  in  other  words,  keeping  him  up  out  of  the  mud. 

The  capacity  of  the  solid  surface  of  terra  firma, 
under  the  perpetual  paddle  of  feet  or  the  grind  of 
heels,  for  turning  into  a  semi-liquid  and  churning 
itself  into  a  sticky  sea  of  bottomless  mud  is  simply 
limitless  and  incredible  —  until  seen  or  felt. 

The  driest  and  firmest  and  most  porous  patch  of 
the  brown  surface  of  Mother  Earth  only  needs  a  little 
puddling  during  a  steady  rain  to  turn  into  a  gummy, 
rubbery  sponge  which  holds  water  as  bread  dough 
does  gas,  and  which  possesses  a  fiendish  power  of 
apparently  eating  its  own  way  down  into  the  depths. 

So,  when  a  regiment  sits  down  upon  a  particular 
plot  of  acres,  and  proceeds  to  make  itself  at  home, 
the  runways  over  which  it  passes  backward  and  for- 
ward upon  its  lawful  occasions  rapidly  turn  them- 
selves into  winding  troughs  of  sticky  glue,  until  the 
camp  seems  to  be  in  danger  of  literally  miring  down. 


KEEPING  THE  CAMPS  HEALTHY    263 

This  is  no  mere  figure  of  speech  so  far  as  man's 
faithful  partner  in  warfare,  the  horse,  is  concerned. 
I  talked  with  one  French  artillery  officer,  who  was 
heartbroken  over  the  sufferings  of  his  poor  horses. 
He  said  that  during  the  winter  it  had  been  necessary, 
for  military  reasons,  to  keep  them  picketed  or 
*' stabled  "in  an  open  field,  with  no  roof  over  them. 
The  ground  was  fairly  porous  and  well  drained  to 
start  with.  The  horses  were  well  fed  and  carefully 
blanketed  so  as  to  protect  them  as  much  as  possible. 
But  there  was  a  steady  succession  of  light,  pelting 
rains,  and  under  their  constant  stamping  and  shuf- 
fling, the  ground  beneath  them  steadily  and  relent- 
lessly churned  itself  into  a  bog  of  mud,  first  fetlock 
deep,  then  knee-deep,  until  they  literally  seemed  to 
sink  into  the  earth,  and  the  hostlers  would  have  to 
go  round  in  the  morning  and  pull  some  of  the  horses, 
which  had  been  rash  enough  to  attempt  to  lie  down, 
out  of  the  bog  in  which  they  were  embedded. 

It  was  impossible  to  move  the  horse-lines,  because 
this  was  the  only  patch  of  ground  of  sufficient  size, 
within  reach  of  the  battery,  which  was  protected  from 
the  enemy's  fire.  And  my  lieutenant,  who  evidently 
loved  his  horses  as  if  they  were  his  own  children,  said 
he  never  felt  more  relieved  in  his  life  than  when  at 
last  the  battery  received  orders  to  move  and  he  could 
get  his  pets  once  more  under  a  roof  and  with  warm, 
dry  bedding  underneath  them. 


264  THE  DOCTOR  IN  WAR 

In  the  earlier  days  of  the  war,  the  condition  of  the 
men  in  the  trenches  was  not  so  very  distantly  re- 
moved from  that  of  the  unfortunate  artillery  horses. 
They  were  literally  up  to  their  knees  and  often  up  to 
their  hips  in  mud,  not  only  in  the  trenches,  but  on 
the  paths  and  roads  they  had  to  flounder  along  back 
to  the  Ccimps  and  huts,  and  even  between  the  huts 
themselves. 

But  all  this  has  long  been  changed  for  the  better 
and  largely  got  rid  of;  partly  by  greater  skill  and  care 
in  the  surface  drainage  of  the  camps,  partly  by  laying 
down  solid  paths,  like  little  roads,  with  broken  stone 
and  ashes,  and  even  empty  tin  cans,  smashed  flat, 
but  chiefly  by  one  very  simple,  but  magnificently 
useful  and  effective,  device,  known  as  the  "duck- 
walk"  or  ''duck-board." 

These  "duck- walks,"  to  the  honor  of  the  New 
World  be  it  said,  are  an  American  institution,  intro- 
duced by  the  Canadian  troops,  and  are  nothing  more 
nor  less  than  the  primitive  grating  or  battened  side- 
walks of  the  lumber-camps  in  the  Big  Woods,  made 
of  two  pieces  of  two-by-four  scantling,  about  sixteen 
inches  apart,  with  battens  of  rough  one-inch  strips 
nailed  across  them,  an  inch  or  two  apart.  They  are 
usually  made  in  about  eight-foot  lengths,  so  that 
the  sections  can  readily  be  picked  up  and  carried 
to  be  laid  wherever  needed;  and  for  all  their  sim- 
plicity, they  are  regular  life-savers.   The  mud  was 


KEEPING  THE  CAMPS  HEALTHY    265 

not  only  extremely  disagreeable  and  destructive  to 
clothing,  to  say  nothing  of  reducing  the  speed  of  all 
operations  over  the  surface  from  fifty  to  seventy-five 
per  cent,  but  it  was  extremely  unhealthy.  It  worked 
its  way  through  the  boots  and  puttees  and  clothing 
of  the  men,  and  caused  distressing  irritations  and 
inflammations  of  the  skin;  one  form  of  which  cul- 
minated in  the  dreaded  "trench  feet"  or  ''trench 
gangrene." 

This  was  little  to  be  wondered  at,  because  sanitary 
arrangements  are  very  difficult  to  carry  out  thor- 
oughly and  scrupulously  under  almost  incessant  shell- 
fire.  The  mud  could  hardly  be  described  as  clean 
mud,  as  there  were  from  five  thousand  to  seven  thou- 
sand men  to  each  mile  of  trench,  and  in  the  earlier 
days  of  the  war,  when  no  one  had  any  idea  of  its 
ghastly  permanence,  the  dead  had  been  buried  pretty 
much  where  they  fell,  in  some  instances,  under  heavy 
fire,  in  niches  scooped  out  in  the  walls  of  the  trenches 
themselves. 

Not  only  did  serious  results  come  from  the  wet 
mud,  but  quantities  of  it,  of  course,  dried  on  and 
stuck  to  the  clothing  or  was  tracked  into  the  huts, 
where  it  turned  to  dust  which  both  irritated  the 
noses  and  throats  of  the  men  and  greatly  favored 
the  breeding  of  fleas  and  other  even  more  intimate 
parasites. 

Altogether,  the  soldier's  grumbling  about  the  mud, 


266  THE  DOCTOR  IN  WAR 

which  he  regarded  as  a  far  more  annoying  enemy 
than  the  Kaiser  and  worse  hardship  than  shell-fire, 
had  abundant  justification;  it  is  literally  a  plague  and 
pest,  and  the  good  influence  which  has  been  most 
powerful  in  exorcising  it  has  been  the  blessed  "duck- 
walk."  It  can  be  laid  almost  overnight;  it  will  not 
sink  into  the  ground,  even  in  the  boggiest  spots,  but 
half- floats,  half-spraddles  itself  above  the  bog ;  it  can 
be  laid  upon  supports,  thrown  across  the  bottoms  of 
the  trenches  and  raised  or  lowered  according  to  the 
ebb  and  flow  of  the  slimy  tide  of  mud. 

Crushed  stone  is  excellent,  if  you  have  plenty  of  it, 
but  short  lengths  of  it  will  be  literally  buried  under 
the  tons  of  mud  deposited  on  it  by  hundreds  of 
hurrying  feet,  and  no  rain  will  wash  it  clean,  while 
the  "duck-board,"  by  virtue  of  its  porousness  and 
lightness,  is  almost  self-cleaning  and  comes  up  fresh 
and  smiling  after  a  shower. 

I  was  talking  with  a  group  of  prominent  officers  of 
the  Army  Medical  Corps  —  colonels  of  the  Sanitary 
Staff  —  and  the  question  happened  to  come  up : 
which  had  been  the  greatest  medical  invention  of  the 
war?  One  said  the  anti- typhoid  vaccine,  another  the 
Carrel  treatment,  the  third,  the  "duck-boards";  and 
he  pretty  nearly  succeeded  in  convincing  the  other 
two  that  he  was  right. 

I  had  equally  convincing  testimony  from  another 
point  of  view,  in  conversation  with  a  prominent 


A  STRETCHER-BEARER  PARTY   COMING  THROUGH   THE  MUD 


A  BRITISH  TOMMY   HELPING   A  GERMAN  PRISONER   CARRY   A 
WOUNDED   GERMAN   THROUGH  THE  TRENCHES 


KEEPING  THE  CAMPS  HEALTHY    267 

Army  Engineer  on  the  Western  Front.  After  talking 
about  the  great  variety  and  huge  amounts  of  material 
required  by  a  modern  army,  he  asked  me:  ''Now, 
what  do  you  suppose.  Doctor,  is  the  most  pressing 
need  of  the  Army  at  present?"  I  guessed  steel  rails. 
"No,"  he  said,  "it  isn't;  it's  crushed  stone  for  the 
paths  about  the  camps  and  the  roads  leading  up  to 
the  trenches." 

Swift,  safe,  certain  movement,  in  all  weathers, 
whether  of  men,  munitions,  or  food,  or  wounded,  is 
the  very  life-blood  of  an  army. 

The  name  "duck-board"  seems  to  have  been  given 
to  them  in  affectionate  derision  by  the  English  troops 
because  they  resemble  the  little  ladders  or  slatted 
boards  laid  for  poultry  to  walk  up  to  their  houses 
or  roosting-places,  perhaps  also  in  allusion  to  their 
web-footed  and  unsinkable  qualities.  The  French 
troops,  who  have  also  adopted  them,  have  an  equally 
farmyard  name  for  them,  "caillebottis,"  which  means 
curd-racks  —  the  slatted  racks  on  which  curds  drain- 
ing for  cheese  are  placed  in  the  dairies. 

Germs  have  their  victories  no  less  renowned  in 
war  than  in  peace.  The  soldier's  worst  enemy  enlists 
with  him,  and  the  deadliest  foe  and  the  thing  that 
kills  most  men  in  war  is  not  bullets,  but  bugs  and 
bacilli.  Whenever  you  mobilize  and  call  to  the  colors 
a  thousand  men,  you  call  with  them  at  least  twenty 


268  THE  DOCTOR  IN  WAR 

billion  tubercle  bacilli,  ten  billion  typhoid,  five  billion 
pneumonia,  and  a  couple  of  million  each  of  the  germs 
of  measles,  cerebro-spinal  meningitis,  diphtheria,  and 
rheumatism. 

In  other  words,  there  will  be  twenty  cases  of  half- 
healed,  chronic  or  latent  consumption,  ten  who  have 
recovered  from  typhoid  but  are  still  "carriers"  of  the 
bacilli,  five  at  least  whose  noses  and  throats  are  still 
swarming  with  pneumonia  germs,  and  two  each  who 
still  carry  about  with  them  odd,  surviving  colonies 
of  the  germs  of  measles,  diphtheria,  meningitis,  and 
even  mumps. 

The  younger  the  soldiers  the  more  certain  you  are 
of  a  full  crop  of  these  left-over  germs,  these  "rem- 
nant" bugs  which  are  eager  to  start  a  "bargain  sale" 
spread  whenever  they  are  provided  with  plenty  of 
fresh  customers. 

An  army  assembles  literally  primed  and  loaded  for 
trouble  from  the  inside,  ready  to  break  out  with 
epidemics,  months  before  it  ever  comes  within  gun- 
shot of  the  enemy.  And  it  invariably  does  break  out 
unless  the  Sanitarian  is  sleeplessly  on  the  job  day  and 
night. 

Five  times  as  many  soldiers,  for  instance,  in  our 
Spanish- American  War,  died  of  typhoid  carried  by 
flies  from  open  latrines  containing  the  feces  of  in- 
fected "typhoid-carriers"  to  unscreened  food,  as 
fell  by  Spanish  bullets.   Nearly  twice  as  many  Eng- 


KEEPING  THE  CAMPS  HEALTHY    269 

Hsh  soldiers  died  of  the  same  disease,  spread  in  the 
same  manner,  in  the  Boer  War,  as  fell  in  battle. 

Just  why  and  how  there  should  occur  this  extra- 
ordinary explosion  and  expansion  of  disease  among 
groups  of  healthy  young  men  in  the  very  prime  of 
life,  and  from  germs  which  they  themselves  are  carry- 
ing about  with  them  quite  "unbeknownst"  to  them- 
selves, is  something  of  a  puzzle.  We  have,  of  course, 
a  familiar  parallel  in  the  fierce  epidemics  of  the  same 
diseases  which  so  often  break  out  in  boarding-schools, 
orphan  asylums,  convents,  etc.  It  would  almost 
seem  as  if  a  given  strain  of  germs  was  able  to  adjust 
itself  to  a  particular  age  of  victim,  and  whenever, 
out  of  the  thousands  of  lurking  "carrier"  germs  in 
a  large  "one-age"  group,  one  strain  happened  to  be 
adjusted  to  that  particular  age,  or  became  so  after 
several  trials,  it  would  then  run  like  wild-fire  through 
the  entire  group,  school,  regiment,  or  mining-camp 
as  the  case  may  be;  for  our  Western  mining-camps 
have  also  furious  epidemics  of  pneumonia  and  menin- 
gitis of  this  sort. 

In  fact  a  curious  apparent  parallel  exists  in  the 
plant  world,  as  forestry  experts  have  long  found  by 
bitter  experience,  that  it  is  utterly  unsafe  to  plant 
new  areas  in  "  solid  "  masses  of  one  particular  species 
of  tree,  because  if  a  bacterial  blight,  canker,  or  other 
infectious  disease  gets  a  start  anywhere  in  the  young 
forest  and  gets  "  tuned  "  to  the  key  of  the  species,  it 


270  THE  DOCTOR  IN  WAR 

will  run  through  every  last  acre  of  it  like  a  prairie 
fire.  If,  however,  the  young  trees  are  planted  in 
alternating  bands  or  zones  of  different  species,  and 
the  more  widely  different  the  better,  then  a  dis- 
ease  starting  in  any  one  of  these  is  checked  by  the 
** strange"  belt  on  either  hand  and  can  gather  so 
little  headway  that  it  can  easily  be  brought  under 
control  and  stamped  out. 

Whether  this  is  the  explanation  or  not,  the  annoy- 
ing fact  remains  that  measles,  mumps,  diphtheria, 
and  meningitis  are  the  bane  of  the  training-camps 
whether  in  France,  in  England,  or  at  home  in  our 
cantonments;  so  much  so  that  experienced  com- 
manders distinctly  prefer  city  and  town  bred  recruits 
to  country  bred  ones  because  they  are  far  more  likely 
to  have  had  most  of  these  minor  pests  in  childhood. 
Indeed,  the  difference  was  strikingly  illustrated  in 
this  war,  for  of  all  the  various  British  troops  it  was 
the  Australians,  the  New  Zealanders,  and  the  Cana- 
dians who  suffered  most  severely  from  such  "second 
childhood"  attacks.  The  men  were  superb  physical 
specimens,  none  finer  in  the  whole  Allied  armies, 
but  they  simply  had  been  bom  mostly  in  small  vil- 
lages or  towns  and  isolated  bush  settlements  out  in 
the  open  country  and  so  escaped  exposure  to  one 
or  more  of  these  plagues  of  childhood.  In  support 
of  which  theory  it  was  the  Newfoundland  regiments 
which  suffered  most  severely  of  all,  while  in  the  Eng- 


KEEPING  THE  CAMPS  HEALTHY    271 

Hsh  home  armies  It  was  the  lads  from  the  Orkney 
Islands  and  the  Hebrides  archipelago  who  held  the 
same  unlucky  distinction. 

Incidentally  this  is  no  argument  whatever  for  hav- 
ing these  diseases  in  childhood  and  **  getting  them 
over"  while  you're  young.  On  the  contrary,  all 
these  Colonies  have  among  the  lowest  infant  mortali- 
ties and  childhood  death-rates  in  the  world,  New 
Zealand  the  very  lowest,  33  per  1000  births  as  against 
America's  no  and  England's  120,  while  there  is  good 
reason  to  ascribe  part  of  the  superb  physique  and 
high  average  stature  of  these  young  recruits  to  their 
escape  from  the  prostrating  and  chronic  poisoning 
after-effects  of  these  serious  and  much  underestimated 
"little"  diseases  of  childhood. 

The  total  net  disadvantage  of  such  escape  is  simply 
a  little  temporary  annoyance  to  a  few  Army  doctors 
and  drill  sergeants,  and  we  can't  inoculate  the  whole 
world  just  to  suit  their  convenience;  especially  as  we 
hope  it  will  never  be  necessary  again,  at  least  in  our 
lifetime,  and  won't  be  when  we  get  all  the  Boche 
Beast's  teeth  drawn. 

The  actual  effects  of  these  belated  children's  dis- 
eases in  training-camps,  although  very  annoying,  are 
usually  comparatively  slight  and  temporary,  with 
the  exception  of  meningitis  and  diphtheria. 

But  they  seriously  interfere  with  training,  occa- 
sionally assume  very  severe  and  even  fatal  forms,  and 


272  THE  DOCTOR  IN  WAR 

if  allowed  to  spread  unchecked  would  unquestionably 
result  in  the  disabling  for  months,  and  even  years, 
of  a  considerable  number  of  fine  young  goldiers.  Even 
when  promptly  recovered  from,  they  often  leave  the 
bronchial  tubes,  heart,  and  kidneys  in  a  weakened, 
irritable  condition  for  months  afterwards,  or  are  fol- 
lowed by  secondary  pneumonias  of  great  severity,  as 
painfully  illustrated  in  our  cantonments  last  winter 
and  during  the  influenza  plague  this  fall. 

The  only  protection  against  them  is  ceaseless 
watchfulness  on  the  part  of  the  regimental  surgeons, 
to  detect  and  isolate  the  very  first  cases  at  the  earliest 
possible  moment.  One  of  the  first  sanitary  require- 
ments of  a  camp  nowadays  is  an  isolation  ward  or 
small  hospital  for  all  cases  showing  any  signs  or  even 
suspicious  symptoms  of  any  sort  of  infection,  includ- 
ing *' common  colds":  "tonsillitis  wards"  as  they 
are  called. 

If  diphtheria  appears,  in  addition  to  isolation  of 
patients,  preventive  doses  of  anti-toxin  are  given 
to  all  whom  they  have  come  in  contact  with,  and 
everybody's  throat  is  examined  and  ''swabbed"  for 
bacteriological  examination  to  detect  "carriers"  of 
the  germs.  Then  they,  too,  are  isolated  till  their 
throats  are  cleaned  up  by  sprays  and  anti-toxin.  It 
is  not  necessary  to  give  anti-toxin  to  those  who  give 
a  clear  history  of  a  previous  attack  or  who  react  to 
a  skin  test  or  "vaccination  "  known  as  the  Schick  test. 


KEEPING  THE  CAMPS  HEALTHY    273 

Measles,  though  less  directly  serious,  is  very  diffi- 
cult to  check,  because  its  most  infectious  stage  is 
before  the  patient  shows  any  signs  of  disease  or  even 
feels  sick.  Indeed,  the  recently  claimed  germ  of  the 
disease  has  disappeared  entirely  from  the  patient's 
body  before  the  rash  breaks  out. 

Fortunately,  however,  one  of  our  American  Army 
sanitarians  has  discovered  that  the  germ  is  quickly 
killed  by  direct  sunlight,  and  if  all  the  bedding, 
clothing,  and  entire  kit  of  the  recruits  are  spread  out 
in  the  hot  sun  every  day  for  two  or  three  days  in  suc- 
cession, the  further  spread  of  the  disease  is  usually 
promptly  checked. 

The  most  serious  alarm  of  all  was  caused  by  the 
series  of  small  epidemics  of  cerebro-spinal  meningitis 
(''spotted  fever")  which  occurred  among  the  Ca- 
nadian and  other  Colonial  troops  in  their  training- 
camps  in  England  early  in  the  war  and  as  soon  as 
we  came  into  the  war  in  our  cantonments  at  home. 
In  this  case  it  was  doubtful  whether  the  infection 
was  brought  by  the  troops,  or  whether  it  was  caught 
from  the  surrounding,  civilian  population,  with  the 
balance  of  evidence  in  favor  of  the  latter  source. 

The  disease  proved  extremely  obstinate  and  diffi- 
cult to  stamp  out,  and  though  by  the  vigilance  of  the 
Army  sanitarians  the  total  cases  were  kept  down  to 
a  few  hundreds  and  the  deaths  to  a  few  score,  yet  it 
was  a  hard,   troublesome  long-drawn-out  fight  to 


274  THE  DOCTOR  IN  WAR 

clean  it  up  altogether,  and  the  end  was  only  reached 
a  few  months  ago.  The  most  effective  means  of  pre- 
venting it  was  found  to  be  antiseptic  sprays  of  thymol 
or  dichloramin  in  the  noses  and  throats  of  all  "sus- 
pects," "carriers,"  and  "contacts";  that  is,  all  who 
had  carried  the  germs  of,  or  had  come  in  contact 
with,  the  disease:  for  epidemic  meningitis  enters  the 
system  through  the  nose  and  is  spread  by  sneezing 
and  coughing. 

Of  course,  from  the  deadliest  plague  and  heaviest 
curse  of  army  camps,  typhoid,  our  troops  have  been 
completely  and  triumphantly  delivered  in  this  war 
by  the  anti-typhoid  vaccine. 


XVI 

THE  PROBLEM  OF  TUBERCULOSIS 

AT  first  sight  scarcely  any  two  things  could  be 
more  strikingly  different  and  diametrically  op- 
posed to  each  other  than  war  and  consumption.  As 
a  mode  of  death  the  one  is  swift,  vivid,  dramatic;  the 
other,  slow,  feeble,  colorless.  It  was  the  proud  ambi- 
tion of  all  the  old  fighting  men  of  song  and  story  to 
die  in  battle,  ''with  their  boots  on,"  and  their  great- 
est dread  and  horror  was  *'a  straw  death,"  a  feather- 
bed end,  after  a  lingering  decline. 

The  warrior  and  the  consumptive  are  just  about 
at  the  opposite  poles  of  human  possibilities.  Yet  up 
to  thirty  years  ago  the  warrior  who  enlisted  for  a  long 
war  had  about  twice  the  chance  of  dying  of  consump- 
tion that  he  had  of  falling  on  the  field  of  battle,  and 
to  this  day  the  commonest  cause  of  death  among 
armies  in  barracks  is  tuberculosis. 

The  reason  for  this  rather  surprising  and  half- 
incredible  state  of  affairs  is  a  fairly  simple  one.  It  is 
along  the  line  of  the  old  Latin  saw  about  Cerium 
non  animum  mutant ;  we  can  change  our  climate,  but 
not  our  disposition,  or,  in  modem  terms,  our  outside 
habits,  but  not  our  inside  bugs. 

Ninety  per  cent  of  us  are  *' loaded"  with  the  tuber- 


276  THE  DOCTOR  IN  WAR 

cle  bacillus  from  our  childhood  days  —  one  or  more 
slumbering  colonies  of  him  tucked  away  in  some  part 
of  our  internal  anatomy.  Whenever  we  become  suffi- 
ciently depressed,  and  out  of  sorts  from  any  cause, 
to  soften  and  weaken  the  wall  that  imprisons  him, 
out  he  comes  ready  for  war. 

Whenever  the  food-supply  of  the  soldier  becomes 
bad  or  scanty,  when  his  water  becomes  foul  or  his 
sleeping-places  verminous,  when  he  is  crowded  and 
packed  into  winter  quarters  in  caves  dug  in  the  hill- 
sides or  in  shacks  covered  with  earth,  when  he  has 
wasted  away  from  the  hectic  fever  and  heavy  sup- 
puration of  festering  wounds,  then  the  tubercle  bacil- 
lus claims  him  as  its  own  and  carries  him  off,  just 
as  it  would  a  half-starved  sweat-shop  worker  in  an 
attic  or  an  overworked  slavey  in  a  cellar  kitchen. 

In  the  sixteenth  and  seventeenth  centuries  gallop- 
ing consumption  and  tuberculous  pneumonia  were 
high  among  the  plagues  which  melted  away  troops 
in  their  winter  encampments  faster  than  the  on- 
slaughts of  the  enemy  could  in  the  field. 

So,  when  this  war  broke  out  and  began  to  assume 
its  underground  character,  with  the  troops  half- 
buried  in  the  trenches  all  day  and  completely  so  in 
dug-outs  and  cellars  and  underground  shelters  at 
night,  sanitary  experts  were  quite  prepared  to  expect 
a  serious  and  widespread  outbreak  of  tuberculosis 
in  their  ranks.  But  for  the  first  two  years  of  the  war 


THE  PROBLEM  OF  TUBERCULOSIS    2^^ 

they  were  most  agreeably  disappointed;  instead  of 
the  troops  in  the  field  showing  more  tuberculosis 
than  in  previous  open  or  aboveground  wars  or  in 
civil  life,  they  actually  showed  far  less.  Indeed,  the 
general  health  of  the  soldiers  in  the  field  was  better 
and  their  disease  and  death-rate  less  than  the  average 
of  soldiers  in  barracks  before  the  war.  With  certain 
exceptions  which  will  be  discussed  later,  our  success 
against  tuberculosis  has  been  almost  as  complete  in 
this  war  as  it  has  against  typhoid,  typhus,  diarrhoea, 
dysentery,  and  cholera. 

This  gratifying  result  seems  to  have  depended 
largely  upon  two  things  —  food,  and  protection  from 
other,  even  slight  infections.  The  tubercle  bacillus, 
like  the  poor,  we  have  always  with  us,  and  when- 
ever he  can  he  will  do  us  ill,  but  the  two  things 
that  give  him  the  best  and  most  favorable  openings 
are  starvation  and  other  infections,  notably  typhoid, 
measles,  and  common  colds.  From  both  of  these 
wicked  partners  the  superb  food-supply  of  our  armies 
in  the  field,  and  the  relentless  and  successful  fight 
waged  by  the  Sanitary  Corps  against  all  infections 
of  every  sort,  big  and  little,  have  protected  our  armies 
in  Flanders  more  perfectly,  probably,  than  any  like 
body  of  men  was  ever  protected  before. 

The  one  unfavorable  influence  —  the  half-under- 
ground character  of  the  fighting  and  the  poorly  ven- 
tilated and  lighted  sleeping-places  that  the  soldier 


278  THE  DOCTOR  IN  WAR 

has  been  compelled  to  occupy  both  in  the  fighting 
hne  and  reserve  —  appears  to  have  been  completely 
neutralized,  partly  by  the  rich  and  abundant  food, 
and  partly  by  the  merciful  fact  that  when  strong, 
vigorous  men  in  the  prime  of  life  spend  the  greater 
part  of  their  working  hours  in  active  exercise  in  the 
open  air,  they  seem  to  be  able  to  consume  their  own 
smoke  at  night  and  sleep  in  almost  any  kind  of  a 
cave  or  kennel,  for  some  time,  at  least,  without  obvi- 
ous damage.  As,  for  instance,  Banks  fishermen,  who 
literally  choke  the  lamp  out  by  exhausting  the  oxygen 
on  stormy  nights  in  their  air-tight  fo'castle,  and 
farmers  whose  bedroom  windows  are  hermetically 
sealed  all  winter. 

Not  only  has  there  been  no  new  development  of 
tuberculosis  in  healthy  soldiers  under  the  strains  and 
hardships  of  war,  but  many  even  known  to  be  tuber- 
culous before  enlistment  or  conscription  have  gained 
weight,  improved  in  health,  and  made  active  and 
useful  soldiers. 

Bumand  declares  that  many  tuberculous  patients 
actually  escaped  from  French  sanatoria  and  enlisted, 
and  that  the  majority  of  them  kept  up  well  and  ren- 
dered excellent  service. 

Faginoli  reports  that  many  Italian  and  Austrian 
consumptives  in  the  incipient  stage  went  to  the  Front 
and  were  greatly  improved  by  active  service. 
^  Banks  traced  forty-eight   known  cases,  most  of 


THE  PROBLEM  OF  TUBERCULOSIS  279 

them  former  sanatorium  cases,  who  were  accepted 
by  the  English  Draft  Boards,  and  nineteen  of  them 
were  sent  into  active  service,  and  out  of  the  whole 
number  only  one  broke  down ! 

In  Osier's  opinion  the  number  of  latent  tubercu- 
lous who  broke  down  in  military  service  was  less  than 
might  have  been  expected  if  they  had  remained  in 
civil  life. 

Fishberg,  after  a  careful  and  thorough  study  of  the 
literature  of  all  the  warring  countries,  concludes  that 
the  morbidity  and  mortality  from  tuberculosis  among 
the  belligerent  nations  has  not  increased  during  the 
war. 
^  Renon  in  France  declares  that  there  was  no  in- 
crease of  tuberculosis  either  in  the  Army  or  among 
the  civil  population  during  the  first  three  years  of 
the  war. 

And  all  authorities  are  agreed  that  such  tubercu- 
losis as  does  occur  among  the  soldiers  is  invariably 
the  reactivation  of  an  old  focus,  the  awakening  of  a 
dormant  infection,  which  existed  long  before  the 
war,  as  clearly  shown  by  the  histories. 

General  Tuffier  told  me  personally  that  he  had 
known  numbers  of  men  with  old  healed  or  dormant 
tuberculosis  who  had  entered  the  Army  and  gained 
weight  and  strength,  as  if  they  had  taken  an  open- 
air  course. 
■  The  one  element  of  the  diet  which  has  probably 


28o  THE  DOCTOR  IN  WAR 

contributed  most  to  this  splendid  showing  against 
the  tuberculosis  devil  and  all  his  works  has  been  the 
abundance  of  meat.  Everywhere  one  goes  along  all 
the  Fronts,  one  is  struck  by  the  fact  that  meat  in 
some  form  appears  upon  the  mess-tables  and  in  the 
ration-tins  at  almost  every  meal,  bacon  or  ham  or 
hash  for  breakfast,  roast  meat  for  dinner,  and  cold 
meat,  ragouts,  goulashes,  and  other  meat  stews  with 
vegetables  for  supper. 

On  the  clay  flats  of  Flanders,  on  the  rolling  hills  of 
the  Somme,  on  the  greerTmountains^xi^^Aisace,  and 
along  the  Alpine  ridges  of  the  Italian  front,  when  the 
rationing  parties  began  to  distribute  their  burden  to 
the  men  in  the  trenches,  I  found  the  leading  dish 
always  a  generous  can  of  hot,  savory,  comforting 
meat  stew,  for  each  Tommy,  Poilu,  Yank,  or  Alpini. 
And  the  men  simply  thrive  on  it. 

Never  has  there  been  a  more  convincing  refutation, 
upon  a  larger  scale,  of  the  silly  old  superstition  that 
meat  is  merely  a  luxury,  that  we  should  be  healthier 
without  it,  and  that  its  extensive  use  is  followed  by 
all  sorts  of  maladies  and  mischiefs.  Seven  million 
men  on  the  Western  Fronts  have  now  for  more  than 
two  years  had  almost  all  the  meat  they  could  eat,  at 
least  twice  and  often  three  times  a  day,  and  the 
special  diseases  and  disasters  which  were  supposed 
to  be  caused  or  aggravated  by  meat-eating  —  gout, 
rheumatism,  arterio-sclerosis,  Bright's  disease,  liver 


THE  PROBLEM  OF  TUBERCULOSIS  281 

trouble,  and  paralysis  —  have  been  strikingly  con- 
spicuous by  their  absence. 

The  only  exceptions  which  could  even  be  claimed 
by  the  "  meatophobes "  are  a  curious  type  of  mild 
inflammation  of  the  kidneys,  known  as  trench 
nephritis,  which  is  now  practically  proved  to  be  due 
to  other  causes,  and  an  increase  noted  by  some 
Army  surgeons  of  irritability  of  the  skin  and  a  ten- 
dency to  dermatitis.  But  the  skin  irritability  has  a 
way  of  almost  entirely  disappearing  under  the  simple 
remedy  of  two  hot  shower  baths  a  week  instead  of 
one. 

Everywhere  you  go  along  the  lines  the  armies  are 
simply  radiant  with  health  and  vigor,  with  spirits  to 
match,  and  if  a  liberal  meat  diet  could  produce  one 
fifth  of  the  evil  consequences  which  many  of  our  dieti- 
tians, both  lay  and  medical,  so  confidently  ascribe 
to  it,  they  would  surely  have  begun  to  show  them- 
selves somewhere,  in  some  measure,  before  this  time. 

In  an  army,  as  in  a  nation,  vigor,  both  physical  and 
mental,  and  progressiveness  run  in  proportion  to  the 
amount  of  meat  consumed  per  capita  up  to  ninety 
pounds  per  annum.  The  only  reason  under  Heaven 
why  any  nation,  or  class  in  a  nation,  does  not  eat 
abundance  of  meat,  at  least  twice  a  day,  is  that  it 
can't  get  it,  either  on  account  of  poverty  or  lack  of 
intelligence.  The  healthiest  and  most  vigorous  rice- 
eating  or  potato-eating  or  cassava-  or  banana-eating 


282  THE  DOCTOR  IN  WAR 

nation  in  the  world  can  be  "fed  up"  to  thirty  to 
fifty  per  cent  higher  working  power  and  healthfulness 
by  a  Hberal  addition  of  meat  to  their  diet. 

What  is  more  to  the  point  in  the  present  instance, 
the  widespread  colonial  experience  of  both  England 
and  France  with  native  troops  has  shown  overwhelm- 
ingly that  almost  any  tribe  or  race  of  black,  brown, 
red,  or  yellow  varieties  of  the  genus  humanum  can  be 
made  into  first-class  fighting  men  by  feeding  upon 
even  an  approach  to  European  army  rations,  con- 
taining meat,  fat,  and  wheat  bread. 

The  next  important  anti-consumption  element  in 
the  Army  ration  has  been  the  liberal  supply  of  good 
bread.  Not  only  has  the  Army  bread-ration  been 
liberal  to  the  point  of  extravagance,  but  the  quality 
of  the  bread  is  much  better  than  that  supplied  to  the 
civil  population.  This  I  found  to  be  the  case  on  prac- 
tically every  Front  that  I  visited,  and  other  observers 
with  whom  I  have  talked  give  the  same  experience. 
Indeed,  outspoken  and  unhesitating  testimony  to  this 
effect  is  volunteered  by  almost  every  Tommy  who 
comes  home  on  leave,  or  poilu  on  "permission."  This 
is  due,  in  part,  to  the  fact  that  the  Army  bakers  and 
cooks,  under  the  watchful  supervision  of  the  Medical, 
Sanitary,  and  Army  Service  officers,  do  their  bread- 
making  more  intelligently  and  carefully.  But  most 
of  it  is  due  to  a  lower  percentage  of  bran  and  other 
indigestible  husks  in  the  flour. 


THE  PROBLEM  OF  TUBERCULOSIS  283 

A  considerable  amount  of  the  Army  flour  has  been 
bought  by  contract  abroad,  and  hence  is  of  the  civil- 
ized or  white  variety.  And  this,  when  mixed  with 
the  eighty-five  per  cent  war-bread  flour,  has  miti- 
gated its  indigestibility.  In  several  places  I  found 
that  the  Army  bakers,  having  their  bread-ration 
issued  to  them  in  the  shape  of  flour,  were  deliberately 
sifting  or  bolting  it  before  making  it  into  bread,  so  as 
to  remove  a  considerable  percentage  of  the  surplus 
bran.  They  told  me  the  rather  curious  and  unex- 
pected fact,  that  by  doing  this  and  sifting  out  the 
branny  particles,  they  could  get  more  loaves  of  bread 
to  the  hundred  pounds  of  flour  than  by  using  the 
whole,  unsifted  flour.  So  that  it  went  just  as  far, 
and  the  men  liked  it  very  much  better. 

Indeed,  the  experience  of  the  Army  is  beginning  to 
raise  a  doubt  in  the  minds  of  thoughtful  supply  ex- 
perts and  Army  doctors  as  to  the  real  and  funda- 
mental economy  of  the  eighty-five  per  cent  war- 
bread  flour.  One  half  of  the  eight  per  cent  saving 
supposed  to  be  effected  by  it  is  known  to  consist  of 
fragments  of  the  husk  of  the  wheat  berry,  which  are 
entirely  indigestible  in  the  human  stomach.  As  these 
fragments  are  not  only  incapable  of  assimilation,  but 
set  up  an  irritation  in  the  stomach  and  intestines, 
with  or  without  diarrhoea,  which  sweeps  away  more 
than  their  own  bulk  of  the  digestible  elements  of  the 
flour  unutilized,  it  is  an  open  question  whether  the 


284  THE  DOCTOR  IN  WAR 

saving  supposed  to  be  effected  by  their  retention  is 
not  a  fallacious  one. 

It  would  be  very  helpful  to  have  careful  experi- 
mental tests  made  upon  squads  of  students  or  sol- 
diers or  other  volunteers  to  see  whether  this  saving 
is  a  real  or  an  imaginary  one,  and  also  to  test  whether, 
if  a  given  amount  of  eighty-five  per  cent  flour  were 
sifted  before  being  made  into  bread,  more  loaves  of 
the  latter  would  be  eaten  per  week  than  of  the  un- 
sifted flour.  Our  American  experience  has  shown  that 
it  is  better  and  wholesomer  to  sift  out  most  of  the 
bran  and  middling,  and  then  dilute  this  white  (sev- 
enty to  seventy-five  per  cent)  flour,  with  the  desired 
proportion,^  usually  about  twenty-five  per  cent,  of 
substitute  flours  from  barley,  rice,  or  com. 

The  third  element  of  importance  in  the  soldier's 
diet  in  keeping  up  his  superb  health  and  high  degree 
of  resistance  against  disease  has  been  the  sugars 
and  their  recognition  as  a  real  food.  In  every  Army 
ration,  on  every  mess-table,  on  the  three  Western 
Fronts,  sugar  in  some  form  —  fruits,  dried,  canned,  or 
preserved,  or  syrup  —  has  been  made  a  regular  and 
substantial  feature. 

The  craving,  gnawing  sense  of  hunger  for  some- 
thing sweet  which  comes  over  a  man  after  two  or 
three  weeks  of  the  old-style  Army  or  lumber-camp 
or  cow-camp  dry  ration,  is  not  only  almost  irresisti- 
ble, but  a  sound  and  wholesome  instinct.   The  first 


THE  PROBLEM  OF  TUBERCULOSIS  285 

and  most  intense  craving  of  our  cowboys,  our  lumber- 
jacks, and  our  miners,  when  they  come  down  to  the 
little  frontier  towns,  is  for  canned  peaches  and  pie 
and  sweet  cake,  their  second  for  whiskey. 

There  can  be  no  question  that  the  remarkable 
sobriety  of  the  huge  armies  of  this  war,  the  rarity  of 
alcoholic  excess  among  our  soldiers,  has  been  closely 
connected  with  the  abundant  and  varied  supplies 
of  that  other  "readily  assimilable  carbohydrate," 
sugar,  either  straight  or  in  the  form  of  dried  fruits, 
preserves,  biscuits,  or  syrup,  in  the  ration.  And  the 
keenest  craving  of  our  boys  on  coming  out  of  the 
trenches  is  for  chocolate,  doughnuts  and  pie,  in  pro- 
viding which,  at  whatever  risk,  the  Y.M.C.A.  sec- 
retaries and  Salvation  Army  lasses  are  winning  their 
way  swiftly  right  to  the  heart  of  the  army. 

A  partial  exception  to  this  general  sweep  of  tri- 
umph over  tuberculosis  would  appear  to  be  the 
French  Army,  in  which,  particularly  within  the  last 
year  or  year  and  a  half,  a  considerable  number  of 
cases  of  tuberculosis  have  been  reported.  The  num- 
bers have  been  variously  estimated  at  from  fifty 
thousand  to  one  hundred  thousand  cases,  —  Armand 
de  Lille,  who  speaks  with  authority,  says  eighty-five 
thousand,  —  but  while  these  figures  look  large  in  the 
mass  and  taken  alone,  when  they  are  placed  against 
a  background  of  nearly  six  million  men  and  figured 
out  on  a  percentage  basis,  they  show  only  about  the 


286  THE  DOCTOR  IN  WAR 

figure  which  might  be  expected  of  men  of  these  ages 
in  civil  Hfe  in  time  of  peace.  Even  the  larger  estimate 
would  figure  out  only  about  one  and  a  half  per  cent, 
while  the  frequency  of  tuberculosis  in  industrial  life 
at  military  ages  is  believed  to  be  between  two  and 
three  per  cent.  The  only  reason  why  tuberculosis 
in  the  French  Army  attracts  attention  is  that  all 
the  soldiers  have  been  kept  under  constant  medical 
observation  and  every  case  reported  and  dealt  with, 
either  by  discharge  or  by  treatment  in  a  sanatorium, 
so  that  the  whole  world  is  made  aware  of  it.  A  similar 
study  of  the  same  number  of  men  in  peaceful  pursuits 
in  any  one  of  the  neutral  countries,  for  instance, 
would  probably  have  uncovered  quite  as  many  cases 
of  tuberculosis,  only,  as  the  old  proverb  has  it, 
**  What  you  don't  know  does  n't  worry  you." 

An  excellent  and  well-arranged  system  of  special 
hospitals  and  sanatoria  for  tuberculous  soldiers  has 
been  planned  by  the  French  Government,  and  an 
important  division  of  the  American  Red  Cross,  backed 
by  the  Rockefeller  Institute,  is  cooperating  with  them 
splendidly  in  giving  these  stricken  defenders  of  their 
country  every  possible  attention  and  chance  of  cure. 

A  genuine  exception  to  the  general  rule  is  among 
the  French  prisoners  in  the  German  prison  camps, 
who  appear  to  be  showing  a  high  rate  of  tuberculo- 
sis, due  to  their  wretched  diet  and  cruel  and  disab- 
ling treatment,  deliberately  planned  to  break  down 


THE  PROBLEM  OF  TUBERCULOSIS  287 

their  health  and  destroy  their  future  fighting  power. 
Also  the  unfortunate  inhabitants  of  some  of  the  war 
zones  just  behind  the  Western  Front.  By  the  steady 
and  ruthless  policy  of  constant  and  indiscriminate 
bombardment  of  everything  that  their  guns  or  air- 
planes can  reach,  particularly  with  gas-shells,  the 
Germans  have  driven  tens  of  thousands  of  these  un- 
fortunate people  to  live  a  considerable  part  of  their 
day  and  the  whole  of  the  night  in  cellars  and  caves 
and  underground  shelters:  with  the  result  —  which 
need  surprise  no  one  —  that  examinations  made  by 
various  civilian  relief  organizations  of  the  women  and 
children  of  these  regions  show  an  appalling  amount 
of  tuberculosis,  ranging  in  some  instances  from  forty 
to  sixty  per  cent  of  those  examined.  But  this,  of 
course,  is  only  a  part  of  the  general  policy,  openly 
avowed  by  the  German  commanders,  that  they  are 
making  war,  not  only  upon  the  French  Army,  but 
upon  the  entire  French  nation,  men,  women,  and 
children. 

Curiously  enough,  such  civil  statistics  as  are  avail- 
able in  France  seem  to  show  that  in  the  mass  of  the 
country,  taking  Paris  as  an  example,  there  has  been 
not  only  no  increase  in  deaths  from  consumption, 
but  an  apparent  decrease.  In  Paris,  for  instance,  ac- 
cording to  the  reports,  there  has  been  a  diminution 
in  both  the  total  number,  and  proportion  per  thou- 
sand living,  of  nearly  ten  per  cent  between  19 13  and 


288  THE  DOCTOR  IN  WAR 

19 1 6.  While,  of  course,  too  much  confidence  cannot 
be  attached  to  these  figures,  on  account  of  the  tre- 
mendous fluctuations  of  both  population  and  propor- 
tions of  various  age  classes,  yet  it  is  in  keeping  with 
the  general  death-rate,  which  shows  a  similar  decline, 
as  reported,  of  about  six  per  cent. 

One  of  the  most  consoling  features  of  this  terrible 
war  has  been  the  way  in  which,  on  account  of  its 
being  waged  chiefly  by  machinery,  elaborate  mechan- 
ical contrivances,  and  munitions,  it  has,  instead  of 
diminishing  industrial  activity  and  output,  increased 
it,  and  has  provided  abundant  occupation  and  higher 
wages  than  ever  before  known  for  practically  every 
man,  woman,  or  child  of  the  civil  population  who  is 
able  to  work.  So  that  the  masses  of  the  people  — 
and  this  is  true  not  only  of  England,  but  of  France 
and  Italy  —  have  far  more  money  to  spend,  and  are 
consequently  better  fed,  better  housed,  and  better 
clothed  than  ever  before  in  history. 

After  rather  careful  and  fairly  extensive  observa- 
tion, I  can  say  that  I  saw  no  signs  of  injurious  food 
scarcity  or  of  underfeeding  in  any  part  or  in  any  class 
of  England,  France,  or  Italy.  Food  is  high,  but  wages 
are  higher. 

There  has  always  been  a  considerable  amount  of 
tuberculosis  in  Northern  and  Northeastern  France 
in  the  coal-mining  and  industrial  populations,  though 
no  higher  than  in  similar  regions  in  Germany  and 


THE  PROBLEM  OF  TUBERCULOSIS  289 

other  European  countries.  So  that  hundreds  of  thou- 
sands of  soldiers  must  have  entered  her  armies  carry- 
ing dormant  foci  or  smouldering  embers  of  partially- 
healed  tuberculosis  in  their  lungs  or  glands.  There 
was  no  time  to  make  elaborate  medical  examina- 
tions; every  man  able  to  shoulder  a  rifle  and  march 
a  couple  of  miles  had  to  be  flung  into  the  ranks  to 
stop  the  onrush  of  the  Beast  and  save  civilization 
from  the  Hun. 

.  -  A  considerable  number  of  these  men  in  the  milder 
forms  and  earlier  stages  of  the  disease  were  stimu- 
lated and  built  up  by  the  outdoor  life  and  good  feed- 
ing and  secured  a  cure,  or  at  least  long-continued 
arrest,  of  the  disease.  Another  moiety  were  tempo- 
rarily improved,  but  were  unable  to  bear  up  under 
the  long-continued  strain  of  the  hardships  and  dis- 
comforts of  the  trenches,  so  that,  about  the  close  of 
the  second  year  of  the  war,  they  began  to  break  down 
and  develop  a  relapse  of  their  ancient  trouble,  and 
the  Army  Medical  Boards,  having  had  time  to  get 
their  breath  and  complete  their  organization,  started 
on  a  thorough  investigation  of  all  the  "reformes,"  as 
the  French  call  those  who  are  invalided  out  of  the 
Army,  and  naturally  discovered  a  considerable  num- 
ber of  these  war-strain  tuberculoses. 

They  faced  the  situation  with  admirable  prompt- 
ness and  intelligence.  An  excellent  system  of  both 
tuberculosis  hospitals  and  open-air  rest-stations  for 


290  THE  DOCTOR  IN  WAR 

the  consumptive  "reformes,"  was  organized  and 
equipped,  one  for  each  of  the  larger  departments  of 
France,  and  provision  was  made  for  special  care  and 
feeding  for  the  graduates  from  these  institutions 
after  they  had  returned  to  their  homes. 

But,  of  course,  this  all  meant  publicity,  and  the 
German  propagandists  and  sympathizers  all  over  the 
world,  particularly  in  America  and  Switzerland, 
and  the  "Defeatists"  in  France,  fairly  leaped  at  the 
chance  and  filled  the  press  and  the  air  with  the  wild- 
est rumors  and  most  unprincipled  falsifications.  The 
French  Army  was  simply  melting  away  with  tuber- 
culosis, a  quarter  of  a  million,  half  a  million,  a  million 
cases  had  already  been  discovered,  and  at  least  as 
many  more  unrecognized  cases  were  in  the  ranks. 
The  real  and  innate  decadence  of  the  French  nation 
had  at  last  revealed  itself,  ran  the  canards,  and  if  the 
war  lasted  for  two  years  more  the  country  would  be 
depopulated  by  tuberculosis! 

Unfortunately,  some  of  the  friendly  medical  ex- 
perts from  the  Allied  countries,  who  visited  France 
to  see  how  they  could  best  assist  her  in  her  campaign 
against  the  disease,  reported  that  the  condition  was  a 
serious  one  in  certain  regions  and  industries,  and  this 
again  was  eagerly  seized  upon  and  unscrupulously 
exaggerated  by  the  enemy. 

But  the  French  authorities  kept  their  heads,  calmly 
went  on  with  their  well-laid  plans,  accepted  cour- 


THE  PROBLEM  OF  TUBERCULOSIS  291 

teously  and  gratefully  the  proffered  assistance  from 
their  Allies,  and  proceeded  to  make  the  widespread 
interest  and  deep  concern  over  the  ravages  of  tuber- 
culosis, stirred  up  by  the  war  and  its  developments, 
the  basis  and  excuse  for  a  broad,  magnificently  con- 
ceived, nation-wide  campaign  of  education  and  pre- 
vention against  this  dread  disease. 

Several  of  the  provincial  cities  of  France,  notably 
in  the  Department  of  the  Loire,  had  established 
before  the  war  admirable  systems  for  dealing  with 
tuberculosis,  consisting  of  dispensaries,  children's 
clinics,  open-air  schools,  open-air  sanatoria  for  the 
curable,  and  hospitals  for  the  advanced  cases  of  con- 
sumption. The  organization  of  the  Department  of 
the  Loire  excited  the  admiration  of  all  the  English 
and  American  tuberculosis  experts  who  visited  it. 
It  had  nine  tuberculosis  dispensaries,  a  sanatorium 
with  four  hundred  beds,  and  a  model  farm  attached 
to  it,  an  open-air  country  school  for  children,  two 
hospitals  for  consumptives,  and  a  training-school  for 
tuberculosis  nurses. 

This  is  to  be  taken  as  a  model  by  the  Minister  of 
the  Interior,  and  similar  systems  are  to  be  developed 
in  at  least  half  of  the  larger  provinces  and  depart- 
ments of  France,  which  will  be  linked  up  with  the 
sanatoria  and  the  hospitals  for  soldiers  discharged 
from  the  Army  on  account  of  tuberculosis.  As  a 
result,  by  the  close  of  the  war,  the  French  will  have 


292  THE  DOCTOR  IN  WAR 

a  chain  of  these  sanatoria  and  hospitals  all  over  the 
country,  linked  up  with  the  local  dispensaries  and 
hospitals  and  the  children's  clinics,  which  will  be 
adequate  to  provide  for  the  needs  of  the  entire  civil- 
ian population.  In  consequence,  there  will,  within  a 
very  few  years,  be  far  less  tuberculosis  in  France  than 
there  was  before  the  war,  and  it  will  be  quite  possible 
within  twenty  years  to  save  almost  as  many  lives 
from  tuberculosis  as  have  been  so  deplorably  sacrificed 
on  the  battlefield  to  the  Hun  greed  for  conquest.  Our 
American  Red  Cross  and  a  special  commission  of 
some  of  the  most  skilled  and  competent  experts  in 
tuberculosis,  supported  by  the  Rockefeller  Founda- 
tion, are  most  liberally  and  helpfully  collaborating 
with  the  French  authorities  in  this  magnificent  work. 
And  just  recently  they  have  equipped  and  sent  out 
a  similar  commission  to  conduct  a  campaign  against 
tuberculosis  in  Italy.  So  that  war  is  not  quite  all 
hell. 


XVII 

THE  PLAGUES  OF  ARMIES 

TWO  great  plagues  have  ever  swept  close  in  the 
wake  of  war  —  drunkenness  and  venereal  dis- 
eases. ^  Mars,  Venus,  and  Bacchus  have  always  been 
closely  grouped  together  since  the  days  of  the  old 
mythologies.  From  one  point  of  view,  their  impor- 
tance has  been  usually  exaggerated  and  overesti- 
mated; as  destroyers  of  life  and  decimators  of  peo- 
ples they  are  among  the  feeblest  and  most  trivial  of 
the  pestilences  that  riot  in  the  soil  turned  up  by 
the  war  plough. 

Typhus  and  typhoid  killed  at  least  a  hundredfold 
as  many  as  both  drunkenness  and  dissipation ;  malaria 
and  pneumonia  each  fifty  times  as  many;  the  little 
bugs  that  get  into  the  wounds  and  cause  septic  or 
surgical  infection  were  at  least  ten  times  as  deadly. 
The  main  reasons  why  these  twin  plagues  stand  out 
in  such  bold  and  vivid  relief  among  the  evils  of  war 
is,  first  of  all,  their  dramatic  and  striking  character; 
second,  that  they  are  due  to  factors  which  are  under 
the  control  of  the  individual  sufferer;  and,  third,  that 
they  continue  to  curse  and  vex  not  only  the  com- 
munity after  the  war  is  over,  but  future  generations 
as  well.   The  soldier  who  dies  of  typhus  or  typhoid 


294  THE  DOCTOR  IN  WAR 

in  the  tented  camp,  or  of  gas-gangrene  or  septic  infec- 
tion in  the  field  hospital,  has  incurred  not  the  slight- 
est element  of  blame  or  reproach;  on  the  contrary, 
he  has  bravely  risked  and  lost  his  life  facing  the  risks 
and  horrors  of  the  war,  and  his  memory  is  revered  as 
that  of  a  hero  and  a  true  patriot.  But  the  soldier 
who  comes  home  from  the  war  with  a  habit  of  alco- 
holic excess  fixed  upon  him,  or  with  the  infection  of 
one  of  the  venereal  diseases  which  he  proceeds  to 
spread  through  the  community  and  to  pass  on  to  his 
helpless  children,  is  a  living  shame  and  a  perpetual 
menace  and  burden  to  his  family,  his  friends,  and  his 
country. 

This  present  war,  terrible  and  world-wide  as  it  is, 
and  destructive  upon  a  scale  never  before  known  in 
history,  has  shown  certain  remarkable  redeeming 
features  which  strengthen  the  hope  of  its  ushering 
in  a  new  and  higher  type  of  civilization,  a  lasting  vic- 
tory of  humanity  over  the  beast.  High  among  these 
stands  its  wonderful  success  in  dealing  with  and  pre- 
venting disease.  Typhoid  has  been  almost  wiped 
out  by  the  anti-typhoid  vaccine;  typhus,  wherever  it 
showed  itself,  stamped  out  by  destruction  of  the 
vermin  which  alone  carry  it;  dysentery  and  diarrhoea, 
reduced  to  the  vanishing  point  by  fly-fighting,  scru- 
pulous purification  of  water,  and  protection  of  food- 
supplies;  tetanus  (lockjaw),  prevented  by  the  routine 
use  of  the  anti-toxin;  and  surgical  skill  saves  ninety 


THE  PLAGUES  OF  ARMIES        295 

to  ninety-five  per  cent  of  all  the  wounded  who  sur- 
vive six  hours. 

Why  should  not  drunkenness  and  syphilis  follow 
suit  with  the  other  diseases  and  be  wiped  out  as  well? 
There  is  no  reason  whatever  why  they  should  not  if 
we  fight  them  as  vigorously,  as  intelligently,  and  as 
openly  as  we  have  typhus  and  typhoid  and  tetanus. 
Indeed,  the  first  of  these  two  Unheavenly  Twins  has 
been  most  successfully  attacked  already.  Not  only 
has  the  world  never  seen  an  army  so  free  from  dis- 
ease as  the  one  under  arms  at  present,  but  also  it  has 
never  seen  an  army  in  the  field  so  sober  and  so  free 
from  disorder  and  crime. 

The  unexpected  has  happened  by  an  almost  in- 
credible paradox.  Instead  of  the  world  having  be- 
come more  drunken  in  time  of  war,  it  has  become 
distinctly  and  strikingly  more  sober.  More  progress 
has  been  made  toward  the  lifting  of  the  curse  of 
drunkenness,  in  Russia,  in  France,  in  England,  in 
three  years  of  this  war  than  in  any  twenty  preceding, 
and  now  the  United  States  has  swung  into  line  by 
the  vote  in  Congress  to  stop,  in  19 19,  the  manufac- 
ture and  sale  of  alcoholic  beverages  during  the  war,  as 
a  means  of  saving  valuable  grain  for  our  food-supply. 
By  a  curious  coincidence,  which  is  anything  but  ac- 
cidental, the  Central  Powers  are  as  barbaric  and  as 
reactionary  upon  this  issue  as  upon  all  the  others 
involved  in  the  war. 


296  THE  DOCTOR  IN  WAR 

The  German  Army  must  have  its  beer  regularly 
just  the  same  as  the  rest  of  its  supplies,  and  in  liberal 
quantities,  and  the  quarters  where  a  German  officers* 
mess  has  been  located  can  always  be  recognized  by 
the  piles  and  heaps  of  empty  wine  and  beer  bottles 
which  surround  it.  Which  accounts  for  part  of  the 
bestial  conduct  of  all  ranks  toward  the  unfortunate 
captives  that  fall  into  their  power,  particularly 
women  and  children. 

It  is  one  of  the  most  astonishing  and  encouraging 
features  of  this  war  that  you  can  walk  for  hours  in 
the  afternoon,  evening,  and  till  late  at  night,  through 
the  streets  of  English  cities,  or  French  villages,  fairly 
swarming  with  soldiers,  French,  English,  Canadian, 
Australian,  Russian,  Italian,  Moroccan,  and  never 
see  a  drunken  or  quarrelsome  soldier.  Here  and  there 
you  will  come  across  one  who  is  a  trifle  exalted  and 
anxious  to  explain  to  an  admiring  public  what  a  fine 
fellow  he  is  and  what  a  splendid  regiment  or  country 
he  belongs  to.  But  even  he  is  a  rare  exception  and  is 
always  under  the  anxious  and  parental  care  of  at 
least  three  or  four  of  his  comrades,  who  are  trying  to 
keep  him  quiet  and  to  get  him  home  to  his  quarters 
as  quickly  as  possible.  To  be  seen  drunk  in  public  is 
evidently  regarded  as  both  very  bad  form  for  the  in- 
dividual and  reflects  discreditably  upon  the  regiment. 
This  natural  tendency  of  the  soldier  toward  restraint 
and  self-respect  has  been  greatly  helped  by  the  most 


THE  PLAGUES  OF  ARMIES        297 

sensible  provision  in  both  England  and  France,  mak- 
ing it  a  punishable  offense  to  offer  a  drink  of  any  kind 
of  alcoholic  beverage  to  a  soldier  or  sailor  in  uniform, 
in  any  public  place. 

What  is  even  more  incredible,  in  London,  in  war- 
time, crime  has  fallen  to  far  the  lowest  level  that  has 
ever  been  known  since  records  have  been  kept!  And 
this  with  the  streets  swarming  with  hot-blooded, 
adventurous  young  fellows,  not  only  from  every  cor- 
ner of  the  United  Kingdom,  but  from  every  quarter 
of  the  world,  many  of  them  back,  for  a  week's  leave 
and  breathing  spell,  from  a  bloody  and  dangerous 
battle  front,  and  anxious  to  get  the  utmost  pleasure 
and  relief  possible  from  the  stern  privations  they  are 
going  back  to,  and  those  streets  in  more  than  semi- 
darkness  all  night  long. 

This  new  standard  of  the  Army  has  had  a  great 
influence  upon  that  of  the  general  public  —  partly 
because  so  many  men  are  in  the  Army,  and  partly 
because  of  the  admiration  of  everything  military 
which  develops  in  war-time.  As  a  result,  combined 
with  higher  wages  and  better  living  conditions,  the 
amount  of  alcoholic  excess,  as  measured  by  the  arrests 
for  drunkenness,  has  fallen  off  sixty  per  cent  since 
the  beginning  of  the  war.  Lord  DAbemon's  latest 
report,  as  Chairman  of  the  Liquor  Traffic  Board, 
declares  that  drinking  in  England  has  diminished 
eighty-five  per  cent ! 


298  THE  DOCTOR  IN  WAR 

So  that  venereal  disease  is  the  only  one  of  the 
plagues  of  war  which  lags  behind,  and  already  a  most 
encouraging  beginning  has  been  made  against  that. 
The  movement  had  started  some  two  or  three  years 
before  the  war,  partly  as  the  result  of  the  general 
awakening  and  enlightenment  of  the  public  health 
conscience;  partly,  and  even  more  powerfully,  be- 
cause for  the  first  time  in  history  we  found  ourselves 
in  possession  of  a  remedy  which  would  not  only  cure 
the  disease  within  a  reasonable  length  of  time,  but, 
what  was  more  important,  would  make  the  patient 
practically  safe,  and  harmless,  as  a  further  source 
of  infection,  within  a  few.  days.  This  was  the  now 
famous  *'6o6"  or  salvarsan,  as  its  name  implies,  an 
ingenious  combination  of  arsenic. 

This  wonderful  boon  will  cure,  roughly  speaking, 
eighty  per  cent  of  all  cases  of  syphilis  in  from  three 
to  five  months,  and,  what  is  far  more  valuable  from 
a  preventive  point  of  view,  clears  the  spirochetes  or 
germs  of  the  disease  out  of  the  blood  within  forty- 
eight  hours  of  the  first  injection  !  This  disappearance 
is  not  permanent,  as  a  fresh  crop  of  the  germs  will 
reappear  in  a  month  or  so,  from  seed-germs  which 
have  taken  refuge  from  the  poison  in  the  deeper  parts 
of  the  body,  probably  the  glands  and  the  marrow  of 
the  bones.  But  it  means  that  if  the  victim  of  syphilis 
is  promptly  discovered  and  treated  with  salvarsan 
and  then  kept  under  observation  at  monthly  inter- 


THE  PLAGUES  OF  ARMIES        299 

vals,  nine  tenths  of  the  risks  of  his  spreading  the  disease 
will  he  wiped  out  I 

Incidentally,  this  is  just  as  much  for  the  advantage 
of  the  patient  as  it  is  for  that  of  the  community,  be- 
cause the  rapid  destruction  of  the  spirochetes  by  sal- 
varsan  not  merely  stops  his  infectiousness  to  others, 
but  also  prevents  the  further  development  of  the  dis- 
ease. So  that,  in  the  majority  of  cases,  the  dreaded 
rash  and  ulcers  in  the  throat,  and  the  falling  of  the 
hair  and  destruction  of  the  bones  and  involvement  of 
the  nervous  system  (locomotor  ataxia,  paresis,  etc.) 
are  completely  prevented.  It  is  hardly  too  much  to 
say  that  the  patient  who  discovers  that  he  has  been 
infected  within  a  month  or  even  two  months  of  his 
exposure,  and  takes  salvarsan,  will,  eight  times  out 
of  ten,  never  know  that  he  has  had  syphilis. 

Naturally  this  encouraged  health  authorities  and 
physicians  to  move  actively  for  the  prompt  recogni- 
tion and  reporting  of  all  cases  of  syphilis,  with  public 
provision  for  its  treatment,  if  necessary,  without 
expense.  One  of  the  ablest  and  most  careful  studies 
of  the  question  was  that  made  by  the  English  Royal 
Commission  on  Venereal  Disease  appointed  in  1913, 
just  a  year  before  the  war.  After  studying  the  prob- 
lem very  thoroughly  and  intelligently  for  two  years, 
it  was  ready  to  report,  but  hesitated  for  some  time 
because,  the  war  being  then  in  full  swing,  it  feared 
that  either  little  attention  would  be  paid  to  the  report, 


300  THE  DOCTOR  IN  WAR 

or  that  nothing  could  be  done  to  put  in  force  its 
recommendations. 

However,  in  the  second  year  of  the  war  it  decided 
to  risk  it,  and  much  to  every  one's  surprise  and 
gratification,  it  found  both  the  pubHc  and  the  civil 
and  military  authorities  in  a  most  receptive  frame  of 
mind.  Most  of  its  practical  recommendations  were 
adopted  at  once,  without  waiting  for  the  action  of 
Parliament,  where  bills  were  introduced  in  both 
Houses  to  improve  the  laws  dealing  with  the  situation. 

Now  the  health  authorities  and  officials  of  all  parts 
of  England  are  prepared  to  offer  to  any  persons  who 
suspect  that  they  may  have  become  infected  with 
syphilis,  first,  a  free  examination  of  their  blood,  by 
the  Wasserman  test,  or  the  Noguchi  test,  which  will 
determine  positively  whether  they  have  syphilis  or 
not;  second,  if  the  infection  is  found  to  be  present, 
free  treatment  with  salvarsan  by  competent  experts 
for  as  long  as  may  be  necessary  to  complete  the  cure, 
and  without  expense  to  the  patient. 

A  similar  arrangement  has  been  established  by  the 
Health  Department  of  New  York  City,  for  four  years 
past,  and  is  giving  admirable  results.  Or  was,  until 
the  New  York  County  Medical  Society,  to  its  lasting 
shame,  rose  up  in  wrath  and  demanded  that  the  free 
treatment  be  stopped,  because  it  was  taking  money 
out  of  the  pockets  of  the  doctors  —  or,  as  they  put  it, 
the  bread  out  of  the  mouths  of  their  families! 


THE  PLAGUES  OF  ARMIES        301 

Much,  of  course,  remains  to  be  done,  principally 
in  three  directions:  First,  education  of  the  public, 
and  particularly  of  the  young.  Including  a  new  stand- 
ard of  biological  morality;  second,  making  the  matter 
first  and  foremost  a  public  health  problem,  and  get- 
ting rid,  as  far  as  possible,  of  the  sense  of  disgrace 
and  special  culpability  and  concealment  about  the 
misfortune;  third,  dealing  with  the  prostitute  as  a 
clearly  mentally  defective  class  and  a  permanent 
menace  to  the  community. 

The  first  of  these  aims  —  education  —  is  rapidly 
being  attained;  one  of  the  most  valuable  and  unex- 
pected results  of  the  report  of  the  English  Royal 
Commission  was  the  full,  thorough,  and  sensible  dis- 
cussion of  It  which  was  given  in  all  the  daily  papers. 
Not  only  was  the  majority  of  the  report  published  In 
full,  but  editorial  after  editorial  appeared  In  the  most 
sacred  columns,  calling  attention  to  the  dangers  of 
neglect  and  delay,  and  even  mentioning  syphilis  right 
out  by  name  in  public  —  which  was  little  short  of  a 
miracle,  considering  the  traditional  attitude  of  both 
the  British  public  and  the  British  press  upon  this 
subject.  And  after  some  hesitation  the  Army  authori- 
ties took  up  the  problem  in  the  training-camps  in  the 
same  spirit,  with  most  gratifying  results.  Talks  were 
given,  first  by  the  Army  doctors  and  then  by  special 
medical  lecturers  who  volunteered  their  services, 
clearly  and  frankly  describing  the  nature  and  risks  of 


302  THE  DOCTOR  IN  WAR 

syphilis  and  gonorrhoea,  and  the  means  of  their  pre- 
vention, with  special  emphasis  upon  the  fact  that 
sexual  indulgence  is  not  in  the  least  necessary  to 
health,  and  that  the  greatest  menace  of  such  illicit 
pleasure  is  to  the  welfare  of  the  next  generation. 

The  importance  of  this  victory  over  stupidity  and 
nasty-mindedness,  calling  itself  modesty,  can  hardly 
be  overestimated:  first,  because  the  judgment  of 
average  humanity  is  surprisingly  sound  and  sensible 
when  once  it  has  the  proper  knowledge  on  which  to 
base  it;  second,  because  the  young  are  cleaner- 
minded  and  more  decent  and  sensible  about  these 
matters  than  the  middle-aged  and  the  old,  popular 
delusions  to  the  contrary  notwithstanding. 

If  we  would  stop  preaching  at  our  boys  and  girls 
about  these  matters,  simply  tell  them  the  facts  and 
let  them  form  their  own  conclusions  as  to  the  wisest 
and  most  honorable  course,  we  should  get  far  better 
results.  The  dangers  of  the  adolescent  period  have 
been  enormously  exaggerated,  and  our  hysterical 
descriptions  to  boys  and  young  men  of  the  terrible 
temptations  and  fierce  struggles  with  their  instincts, 
which  they  are  sure  to  experience  if  they  attempt  to 
behave  themselves  decently  and  sensibly,  do  far  more 
harm  than  good.  It  is  distinctly  doubtful  whether 
adolescence  is  the  period  of  severest  temptation  in 
this  regard;  that  is  to  say,  in  proportion  to  the 
deterrent   and   counter-balancing    influences.     Cer- 


THE  PLAGUES  OF  ARMIES        303 

tainly  the  large  majority  of  those  who  are  brought 
before  our  courts  of  justice  for  sexual  offenses  are 
middle-aged  or  older.  And  the  chief  financial  support 
of  the  red-light  districts  and  the  adventuress  class 
comes  from  so-called  respectable,  middle-aged  mar- 
ried men,  and  not  from  the  age  of  youth  and  adven- 
ture and  romance:  the  young  have  so  many  more 
keen  interests  and  sources  of  pleasure  in  life. 

Even  more  deplorable  is  the  other  traditional  as- 
sumption that  it  is  not  only  natural,  but  necessary, 
for  young  men  to  sow  their  wild  oats,  to  go  through 
a  period  of  experience  and  adventure  in  the  knowl- 
edge of  good  and  evil :  in  fact,  that  their  experience 
and  development  are  not  complete  without  it.  This 
vicious  delusion  did  not  originate  with  the  young, 
nor  is  it  generally  believed  by  them  until  it  has  been 
dinned  into  their  ears  by  the  wisdom  of  their  elders. 
It  was  invented  by  bald  and  graceless  burgesses  of 
the  fifth  and  sixth  ages  of  man,  in  order  to  put  a  halo 
around  their  youthful  adventures  and  follies  and 
render  them  suitable  for  framing  in  their  chuckling 
memories. 

Whatever  its  origin,  it  has  been  responsible  for 
probably  as  many  wrecks  and  misfortunes  and  shame 
as  all  the  hot-blooded  and  uncontrollable  impulses  of 
youth  put  together.  It  is  precisely  of  a  piece  with 
that  other  abominable  social  tradition  that  a  boy 
cannot  count  himself  a  man  until  he  has  learned  to 


304  THE  DOCTOR  IN  WAR 

drink  and  been  at  least  once  or  twice  under  the  in- 
fluence of  liquor.  The  quicker  both  of  them  can  be 
thrown  into  the  limbo  of  exploded  superstitions,  the 
better,  and  there  is  where  the  Army  has  flung  them. 
There  is  not  a  shred  of  foundation  or  basis  in  either 
science  or  common  sense  for  either.  That  there  is  an 
instinct  and  a  powerful  one  urging  in  this  direction 
is  perfectly  true,  but  that  instinct  is  for  the  benefit 
of  the  race  and  not  of  the  individual,  or,  to  put  it 
more  precisely,  it  is  only  when  it  is  helpful  to  the 
race  that  it  is  of  benefit  to  the  individual. 

Another  position  which  we  have  assumed  toward 
this  group  of  diseases  is,  I  think,  unwise,  and  ought 
to  be  modified.  That  is  the  attitude  of  profound  dis- 
grace and  moral  delinquency  which  we  have  visited 
upon  their  unfortunate  victims.  It  is  quite  true  that 
there  is  an  element  of  moral  responsibility  and  blame 
for  these  diseases,  because  they  are  largely  due  to  cir- 
cumstances and  actions  which  are  more  or  less  com- 
pletely under  our  own  control,  and  we  are  justified 
in  laying  a  reasonable  emphasis  on  this.  But,  after 
all,  that  responsibility  is  only  relatively  greater  than 
that  which  exists  in  a  great  many  other  diseases, 
which  come  from  the  violation  of  known  laws  of  con- 
duct and  of  health.  Indeed,  in  not  a  few  cases  it  is 
no  greater,  on  account  of  the  dense  and  lamentable 
ignorance  of  these  subjects  in  which  our  traditional 
ostrich-like  education  has  kept  the  young. 


THE  PLAGUES  OF  ARMIES        305 

At  all  events,  the  most  rational  as  well  as  the  most 
humane  and  helpful  course  is  to  waive  this  overdone 
attitude  of  disgrace  and  moral  reproach  and  to  regard 
the  unfortunate  victims  of  these  diseases  as  patients 
who  ought  to  be  cured  as  promptly  as  possible  and 
wards  of  the  community  who  need  help  rather  than 
scolding  and  denunciation.  Our  first  duty  as  physi- 
cians, parents,  and  philanthropists  is  to  cure  them 
first  and  to  leave  the  preaching  till  afterwards. 

Every  appeal,  every  address  to  boys  on  this  subject 
ought  to  make  it  perfectly  clear  that  if  ever,  in  spite 
of  knowledge  and  good  advice,  their  impulses  should 
get  the  better  of  their  judgment  and  they  should  find 
themselves  in  trouble,  they  are  to  come  at  once  to 
their  nearest  relative,  friend,  or  adviser  and  make  a 
clean  breast  of  it,  and  they  will  be  neither  punished 
nor  scolded,  least  of  all  turned  away  unhelped,  but 
will  be  simply  put  under  the  best  care  and  in  the 
way  of  cure  at  once.  There  is  no  use  either  crying 
or  scolding  over  spilt  milk,  and  there  cannot  be  the 
slightest  doubt  that  the  vivid  dread  of  parental  or 
other  wrath  and  denunciation  furnishes  one  of  the 
richest  fields  of  harvest  for  the  quack  and  the  char- 
latan and  the  blackmailer.  Many  and  many  a  young 
fellow  who  finds  himself  in  trouble  avoids  and  keeps 
away  from  the  competent  expert  or  reputable  physi- 
cian whom  he  knows  and  has  confidence  in  personally, 
particularly  one  who  is  acquainted  with  members  of 


3o6  THE  DOCTOR  IN  WAR 

hiwS  family,  on  account  of  this  dread  of  disgrace  and 
humiliation,  and  resorts  to  the  advertising  blood- 
suckers and  blackmailers,  who  of  course  seek  his  con- 
fidence only  for  the  purpose  of  threatening  to  betray 
it  and  exploit  his  dread  of  exposure  for  all  that  it 
is  worth.  If  parents  would  make  this  perfectly  clear 
to  their  sons,  if  guardians  would  assure  their  wards, 
if  the  modern  type  of  intelligent  employer  would 
make  it  clear  to  the  men  and  boys  in  his  employ- 
ment, that  if  they  come  to  him  promptly  and  frankly 
as  soon  as  they  find  themselves  in  trouble,  he  will 
regard  them  as  sick  first  and  sinners  afterwards  — 
perhaps,  it  would  enormously  help  in  the  battle 
against  these  evils.  And  this  is  exactly  what  the 
Army  medical  authorities  have  done. 

Nor  would  it  lower  the  standard  of  true  manhood 
or  moral  responsibility  one  whit,  for  how  many  of  us 
are  there  that  are  so  entirely  without  sin  that  we  can 
afford  to  cast  the  stone  of  reproach  and  condemna- 
tion? The  boy  who  has  been  saved  by  prompt  and 
kindly  help  from  a  lifelong  menace  or  a  lasting  blood 
taint,  threatening  generations  yet  unborn,  will  be 
far  more  likely  to  heed  the  counsels  of  wisdom  in 
future,  and  to  exercise  a  helpful  influence  among 
those  of  his  own  age,  than  if  he  had  been  left  to  bear 
the  penalty  undiminished  and  the  disgrace  unaided. 
Yet  to  such  an  extreme  have  some  of  our  self-styled 
moralists  gone  in  this  respect  that  they  have  actually 


THE  PLAGUES  OF  ARMIES        307 

decried  the  use  of  salvarsan  and  denounced  the  use  or 
knowledge  of  preventives  of  infection,  on  the  ground 
that  he  who  has  sinned  ought  to  be  allowed  to  bear 
his  punishment  as  decreed  by  an  All- Wise  Provi- 
dence ! 

Last  and  not  least  important  comes  the  frank 
recognition  of  the  prostitute,  not  as  a  **  fallen  sister,*' 
or  an  impulsive,  romantic  victim  of  emotionalism 
and  love  of  pleasure,  but  as  a  poor,  stupid,  unfortu- 
nate feeble-wit,  without  the  slightest  conception  of 
what  either  romance  or  adventure  means,  earning  a 
pitiful  and  sordid  living  by  the  exploitation  of  her 
only  gift,  her  sex,  simply  because  she  is  too  stupid 
and  too  incompetent  to  earn  a  living  in  any  other 
way. 

Expert  mental  examinations  of  thousands  of  these 
poor  creatures  have  shown  two  thirds  to  three  fourths 
of  them  to  be  clearly  and  hopelessly  feeble-minded, 
their  average  mental  age  being  about  that  of  a  child 
of  eleven.  They  should  be  regarded  as  wards  of  the 
State  and  protected  against  themselves  and  their 
filthy  and  contemptible  exploiters,  by  education  in 
beautiful  school  colonies  in  the  country,  until  they 
are  forty-five.  They  could  be  detected  in  advance  by 
simple  mental  tests  at  from  nine  to  twelve  years 
of  age,  and  with  their  segregation  would  disappear 
from  half  to  two  thirds  of  the  wretched  traffic  of 
which  they  are  the  vehicles. 


3o8  THE  DOCTOR  IN  WAR 

It  Is  coming  to  be  the  judgment  of  intelligent  chiefs 
of  police,  vice  commissions,  and  other  students  of  the 
problem,  that  the  prostitute  and  the  red-light  district 
create  at  least  two  thirds  of  their  own  trade.  The 
whole  deplorable  affair  is  a  business,  carefully  organ- 
ized, advertised,  touted  for,  run  hand  in  glove  with 
the  saloons,  and  instinct  or  passion  of  any  sort  has 
astonishingly  little  to  do  with  it.  The  only  people 
who  make  money  out  of  it  are  the  men  who  control 
it  and  not  the  wretched  women;  and  movements  for 
its  control  and  abolition  are  fought  most  viciously, 
not  only  by  the  brothel-keepers,  but  by  politicians, 
pillars  of  the  church  and  society,  merchants  and 
property-owners,  who  make  enormous  profits  out 
of  its  supplies  and  huge  rents  out  of  its  houses.  At 
all  events,  boys  and  young  men,  both  soldiers  and 
civilians,  should  clearly  understand  that  the  woman 
or  girl,  whether  professional  or  amateur,  who  offers 
them  an  adventure  of  this  description,  is  nine  times 
out  of  ten  after  their  money  and  nothing  else. 

Against  dissipation  and  venereal  disease  the  best 
antidotes  and  preventives  are  plenty  of  intelligent, 
wholesome  amusements  of  all  sorts,  particularly 
athletics  and  dances  or  other  forms  of  social  enter- 
tainment, under  proper  auspices.  It  is  the  clear  duty 
of  the  community  to  provide  ample  opportunities  for 
this  free,  happy,  helpful  social  life  among  its  young 
people,  either  through  the  church  social,  the  school 


THE  PLAGUES  OF  ARMIES        309 

party,  or  the  municipal  dance  or  reception  properly 
chaperoned,  both  for  their  health,  happiness,  and  re- 
finement, and  as  an  aid  to  the  romantic  and  delight- 
ful, but  immensely  important  and  serious,  enterprise 
of  choosing  their  partners  for  life. 

If  boys  and  young  men  have  plenty  of  good  women 
and  girls  to  associate  with,  they'll  never  miss  the 
bad  ones.  In  our  American  Army,  both  in  the  home 
cantonments  and  in  France,  provision  is  made  for 
this  most  necessary  and  invaluable  influence  through 
the  admirable  Hostess  Houses  of  the  Y.W.C.A.,  the 
Red  Cross,  and  other  patriotic  organizations. 

In  this  broad  and  intelligent  spirit  venereal  dis- 
ease has  been  attacked  in  the  armies,  and  the  result 
has  been  a  very  triumph  of  common  sense.  From 
the  earliest  days  of  his  training  the  recruit  is  thor- 
oughly and  carefully  instructed  as  to  its  nature  and 
dangers,  either  by  the  regimental  surgeons  or  by 
specially  skilled  speakers  who  make  the  round  of  the 
cantonments.  He  is  put  in  full  possession  of  all  the 
facts,  the  dangers  of  disability  and  disease  empha- 
sized, and  then  his  patriotism  as  a  soldier  who  must 
keep  himself  fit,  his  self-respect  and  his  regard  for 
the  future  of  the  race,  are  appealed  to.  And  superbly 
has  he  responded. 

In  spite  of  all  the  special  temptations  that  assail 
the  soldier  in  the  camp  and  in  the  field,  the  rate  of 
venereal  diseases  in  the  Allied  armies  is  now  less  than 


3IO  THE  DOCTOR  IN  WAR 

half  that  believed  to  exist  among  young  men  of  simdlar 
ages  in  civil  life.  The  disease  has  been  met  frankly, 
not  only  as  a  moral  problem,  but  as  a  sanitary  one, 
taking  every  known  and  effective  means  of  prevent- 
ing or  curing  as  quickly  as  possible  one  of  the  most 
disabling  diseases  to  which  soldiers  in  camps  are 
liable. 

That  the  risks  of  exposure  to  those  diseases  should 
not  be  run  is  accepted  without  question,  but  it  is  held 
that,  in  the  language  of  a  famous  President,  "it  is 
a  condition,  and  not  a  theory,  which  confronts  us." 
And  if  once  the  risk  has  been  incurred,  the  soldier  is 
not  merely  instructed  what  to  do,  but  provided  with 
all  the  necessary  means  for  avoiding  an  infection. 

Prophylactic  stations,  with  hospital  orderlies  in 
attendance,  have  been  established,  not  merely  in 
every  camp  and  camp  hospital,  but  in  our  American 
Army  in  France  in  every  Y.M.CA.  building,  so 
that  the  fullest  opportunity  is  afforded  to  every  man 
to  save  himself.  If  the  soldier  reports  and  avails  him- 
self of  these  facilities,  even  if  he  should  later  develop 
an  infection  it  is  counted  only  as  a  minor  misde- 
meanor; if  he  does  not  so  report,  his  pay  is  docked 
during  the  whole  time  that  he  is  under  detention  and 
treatment. 

What  is  even  more  effective,  the  men  who  develop 
these  infections  are  held  under  constant  surveillance 
in  a  sort  of  movable  quarantine  under  military  guard. 


THE  PLAGUES  OF  ARMIES        311 

They  live  and  eat  and  sleep  in  a  special  hut ;  they  are 
inarched  out  under  guard  for  special  details  of  work, 
separate  from  the  rest  of  the  men;  they  march  back 
to  their  barracks  in  the  evening  and  are  locked  up 
for  the  night. 

The  conduct  of  the  other  troops  toward  this  vene- 
real squad  (only  it  is  called  by  a  shorter  and  much 
less  polite  name)  is  sadly  lacking  in  brotherly  consid- 
eration and  Christian  charity,  and  the  fire  of  humor- 
ous comment  to  which  they  are  subjected  as  they 
march  about  under  guard  is  not  exactly  soothing. 

This  method,  which  is  carried  out  most  perfectly 
in  our  American  Expeditionary  Forces,  works  so  well 
in  practice  that  at  the  time  of  my  visit  it  had  actually 
reduced  the  percentage  of  venereal  disease,  in  a  body 
of  nearly  30,000  troops,  to  one  half  of  one  per  cent! 
And  the  latest  report  of  the  Special  Army  Commis- 
sion on  Control  of  Venereal  Disease,  in  May,  191 8, 
is  that  out  of  half  a  million  men  in  France  only  one 
tenth  of  one  per  cent  are  under  hospital  treatment 
for  social  diseases. 

When  this  is  contrasted  with  the  old  peace  aver- 
age for  the  English  Army,  about  six  per  cent  (to  say 
nothing  of  the  fifty-year-ago  averages,  which  used  to 
run  to  twelve  or  fifteen  per  cent),  and  that  the  best 
ever  attained  before  was  two  per  cent  in  the  French 
Army  and  one  and  three  tenths  per  cent  in  the  Ger- 
man, and  that  these  latter  figures  only  included  the 


312  THE  DOCTOR  IN  WAR 

men  who  were  sufficiently  disabled  to  be  confined  to 
the  hospital,  it  will  be  seen  that  the  method  is  not 
lacking  in  practical  effectiveness. 

In  addition,  the  American  military  police  have 
the  power,  in  the  name  of  "la  defense  nationale," 
promptly  to  deport  from  the  Army  zone,  without 
trial  or  other  troublesome  legal  delays,  all  women 
known,  or  reasonably  suspected,  to  be  prostitutes, 
who  have  come  into  it  since  it  was  occupied  by  the 
Army.  If  London  would  tackle  the  problem  in  the 
same  spirit,  the  disgraceful  and  deplorable  scenes, 
which  are  the  open  scandal  of  the  streets  leading  to 
most  of  its  great  railway  stations  by  which  troops 
enter  the  capital,  would  soon  be  wiped  out.  If  any 
pretext  save  that  of  the  defense  of  the  realm  was 
needed,  it  could  be  found  by  merely  making  a  thor- 
ough mental  examination  of  these  unfortunate  wo- 
men and  then  applying  the  provisions  of  the  act 
for  the  protection  of  the  feeble-minded,  as  from 
seventy  to  eighty-five  per  cent  of  them  have  only  the 
mental  development  of  children  of  eleven. 


XVIII 

THE  EFFECTS  OF  WAR  ON  THE  CIVIL 
POPULATION 

ONE  of  the  most  singular  and  sinister  ironies  of 
war  is  that  its  heaviest  slaughter  is  not  upon 
the  battle-field.  Famine  at  home  and  pestilence  in 
the  tented  camp  have  ever  slain  from  ten  to  twenty- 
fold  as  many  as  the  clash  of  arms  upon  the  open  field. 
It  is  the  men  who  make  the  wars,  and  the  women  who 
pay  for  them. 

In  earlier  wars  the  calling-away  of  all  men  of  mili- 
tary age  to  the  front  meant,  when  most  countries 
were  from  one  half  to  two  thirds  agricultural  in  their 
population,  the  tilling  of  the  land  only  by  women, 
children,  and  old  men,  with  immediate  scarcity  of 
food,  the  shutting-down  of  such  factories  as  existed 
on  account  of  the  lack  of  raw  materials  as  well  as 
labor,  which  meant  unemployment  or  low  wages,  all 
over  the  land  less  money  to  spend,  and  all  food  and 
necessaries  double  or  treble  their  former  price.  Bread 
riots  were  as  regular  an  accompaniment  of  former 
wars  as  bugles  were. 

Consequently,  one  of  our  keenest  interests  as  both 
statesmen  and  students  of  social  conditions,  when 
this  terrific  calamity  broke  over  an  unsuspecting 


314  THE  DOCTOR  IN  WAR 

Europe,  was,  what  would  be  the  recoil  of  the  war  gun 
upon  the  stay-at-homes;  how  would  the  civil  popu- 
lation stand  the  strains  and  stresses  of  war  condi- 
tions? When  I  went  abroad  in  January,  191 7,  after 
a  state  of  war  had  existed  for  over  two  years,  one  of 
my  deepest  interests  was  the  study  of  the  actual 
effects  of  war  upon  national  vitality,  its  reactions 
upon  the  nine  tenths  of  the  people  of  the  Allied  coun- 
tries who  remained  at  home,  rather  than  its  more 
direct  and  obvious  effects  upon  the  one  tenth  who 
were  on  or  near  the  fighting-line.  For  the  reason,  not 
merely  that,  forming  so  vast  a  majority  of  the  nation, 
whatever  affected  them,  even  in  less  striking  degree, 
was  of  even  deeper  vital  importance  than  the  fortunes 
of  those  in  the  trenches;  but  also  that  any  results, 
for  better  or  for  worse,  wrought  among  the  home 
population  would  be  likely  to  be  permanent  and  to 
deeply  affect  the  future  history  of  the  race,  while 
those  wrought  on  the  battle-field,  though  more  dra- 
matic, might  be  much  more  transient  in  character. 

Besides,  the  utmost  results  to  be  hoped  from  tri- 
umphant victory  in  the  war  itself  were  so  meager,  so 
pitifully  inadequate  to  repay  the  blood  and  agony 
which  they  had  cost:  merely  a  return  to  the  status 
quo  J  to  the  position  in  which  the  world  fondly  believed 
itself  to  be  in  the  fatal  summer  of  19 14,  when  reason, 
humanity,  and  justice  were  supposed  to  govern  the 
nations :  the  chaining-up  of  a  homicidal  lunatic  nation. 


THE  CIVIL  POPULATION  315 

that  we  did  n't  even  know  was  crazy,  the  safeguard- 
ing of  civilization  and  democracy  from  a  menace  of 
barbaric  world  conquest  that  we  could  hardly  believe 
existed.  Perhaps  the  reflex  results  at  home  might 
show  a  more  positive  gain,  a  less  barren  triumph,  some 
return  even  partially  worth  while  for  the  wastage  and 
horror  of  it  all. 

Of  course,  the  fortunes  of  the  home  population  are 
far  less  dramatic  and  unusual  and  attract  much  less 
public  attention  than  those  of  the  armies.  From  the 
beginning  the  columns  of  the  newspapers  have  been 
crowded  with  the  most  detailed  reports  of  this  battle 
and  that  skirmish,  with  their  pitiful  lists  of  the  killed 
and  the  wounded,  with  all  the  news  of  camp,  of  hos- 
pital, of  troop-ship,  and  the  murderous  marvels  of 
howitzers,  machine-guns,  and  bombing  airplanes.  But 
only  a  line  here  or  a  paragraph  there  reports  the  wel- 
fare or  ill-fare  of  the  nine  tenths  who  toil  patiently 
at  home,  growing  the  food,  forging  the  guns,  turn- 
ing and  filling  the  shells,  weaving  the  clothing  and 
stitching  the  shoes,  building  the  ships  and  manning 
the  railways  to  supply  and  support  the  one  tenth  in 
the  world's  eye  at  the  Front. 

But  this  comparative  scarcity  of  news  as  to  the 
conditions  among  the  people  at  home  was  really  in 
itself  an  encouraging  sign.  Prosperity  and  well- 
behavior  seldom  make  good  copy,  and  only  misfor- 
tunes or  misdeeds  catch  the  eye  arrestingly  in  the 


3i6  THE  DOCTOR  IN  WAR 

headlines.  ''Happy  is  the  nation  that  has  no  history  " 
was  shrewdly  true  in  the  sense  that  history  is  or  was 
largely  made  up  of  records  of  wars  and  kings  and 
other  calamities.  If  there  are  no  strikes,  if  there  are 
no  bread  riots,  if  there  are  no  famine-bred  pestilences 
to  claim  prominent  space  in  the  newspapers,  the  hope- 
ful presumption  is  that  the  great  working  mass  of  our 
population  is  faring  better  than  usual  in  war-time. 

Within  a  week  of  the  time  that  one  lands  at  Liver- 
pool or  steps  upon  the  historic  soil  of  France,  one 
becomes  aware  by  many  significant  signs  that  this 
present  war  presents  almost  as  many  differences  at 
home  from  conditions  obtaining  in  former  wars  as 
have  been  noted  in  the  trenches.  It  so  happened 
that  I  had  made  various  trips  abroad  for  the  purpose 
of  studying  different  health  conditions,  remaining 
for  two  different  periods  of  nearly  two  years  each,  so 
that  I  was  reasonably  familiar  with  the  physical  and 
hygienic  conditions  of  the  English,  the  French,  and 
the  Italian  peoples;  and  I  was  instantly  struck,  on 
reaching  the  streets  of  Liverpool,  with  the  fact  that  I 
had  never  seen  the  mass  of  the  English  people  looking 
so  well  fed,  so  well  dressed,  and  in  such  good  general 
physical  condition. 

Inquiry  among  my  friends,  both  in  industrial  life 
and  in  the  professions,  particularly  among  the  health 
officers,  almost  universally  confirmed  my  first  im- 
pressions.  The  death-rate,  instead  of  being  higher, 


THE  CIVIL  POPULATION         317 

was  the  lowest  in  years,  in  fact,  had  only  once  been 
surpassed.  Instead  of  a  good  deal  of  malnutrition 
and  diseases  due  to  underfeeding  among  children, 
the  infant  mortality  and  child  death-rate,  after  a 
distinct  rise  during  the  first  six  months  of  the  war, 
had  begun  to  decline  and  was  now  at  the  lowest  level 
ever  known. 

Instead  of  unemployment,  there  was  an  actual 
excess  of  jobs  over  applicants;  wages  had  risen  so 
that  families  were  earning  more  money  than  they 
ever  had  in  their  lives  before.  And  the  one  com- 
plaint that  was  uniformly  voiced  by  my  middle-class 
friends  and  acquaintances  was  that  the  working 
people  were  buying  things  they  had  never  dreamed 
of  possessing  before,  such  as  pianos,  organs,  plush 
upholstered  furniture,  ostrich  feathers,  and  even 
furs  and  jewelry. 

;  More  unexpected  yet,  vagrancy  was  almost  un- 
known; the  poor-houses  were  half-empty;  drunken- 
ness, as  indicated  by  the  number  of  arrests,  had  fallen 
off  from  thirty  to  fifty  per  cent,  and  crime  had  de- 
creased in  the  most  astonishing  fashion,  even  in  spite 
of  the  fact  that  a  large  proportion  of  the  younger  and 
more  active  policemen  had  gone  to  the  Front  and 
that  the  streets  of  all  the  cities  were  in  a  state  of  more 
than  semi-darkness  at  night.  Even  though  the  spokes- 
men of  the  upper  and  middle  classes  were  all  firmly 
convinced  that  the  working  classes  were  getting  far 


3i8  THE  DOCTOR  IN  WAR 

higher  wages  than  they  were  worth,  and  in  the  begin- 
ning of  the  war  had  loudly  lamented  that  they  would 
surely  spend  the  greater  part  of  the  surplus  on  beer, 
they  were  now  admitting  that  their  prophecies  in 
this  regard  had  been  largely  unfounded,  and  that 
most  of  the  munition  workers  were  putting  their  high 
wages  into  more  nourishing  foods,  better  houses, 
more  attractive  clothing,  war  bonds,  and  savings 
banks. 

When  I  had  finished  my  stay  in  England  and 
crossed  over  to  France,  I  found  an  almost  parallel 
situation  existing  there  as  to  the  physical  and  finan- 
cial welfare  of  the  great  mass  of  the  people,  only  in 
less  degree.  This  was,  of  course,  to  have  been  ex- 
pected on  all  grounds,  partly  because  France  has 
much  more  largely  a  farming  population,  and  hence 
there  had  been  an  earlier  and  more  striking  falling-off 
of  and  restriction  in  certain  classes  of  food-supplies, 
while  at  the  same  time  a  much  smaller  portion  of  the 
population  was  benefited  by  the  great  increase  in 
wages.  Also  because  heroic  France  had  borne  the 
full  brunt  of  the  war  right  from  the  very  beginning, 
while  it  had  taken  England  a  year  and  a  half  to  put 
even  an  approximately  large  proportion  of  her  popu- 
lation into  the  field.  Nevertheless,  the  shops  were  all 
open  and  their  windows  crammed  with  goods,  trade 
and  traffic  were  good,  labor  was  scarce,  wages  were 
more  than  doubled,  the  people  were  well  dressed  and 


THE  CIVIL  POPULATION  319 

well  fed,  and  that  most  sensitive  barometer  of  na- 
tional welfare,  the  children,  were  bright-eyed,  plump- 
bodied,  rosy-cheeked,  and  strenuous  of  both  voice 
and  limb  in  their  happy  play. 

Again,  inquiry  among  officials,  business  men,  phy- 
sicians, and  social  workers  corroborated  these  im- 
pressions with  certain  exceptions.  There  had  been 
a  slight  increase  in  the  civilian  death-rate,  an  appar- 
ent increase  in  tuberculosis,  an  increase  in  the  infant 
and  child  mortality  rate  along,  and  from  ten  to  fifteen 
miles  back  of  the  Front,  on  account  of  the  indiscrim- 
inate nature  of  the  German  bombardment.  But  when 
all  was  said  and  done,  the  civil  population  of  France 
was  holding  its  own,  not  only  with  magnificent  cour- 
age and  unconscious  heroism,  but  also  with  most 
gratifying  and  surprising  physical  and  hygienic  suc- 
cess. 

One  reason  for  this  cheering  and  unexpected  state 
of  affairs  on  both  sides  of  the  Channel  was  not  far  to 
seek.  And  that  is  the  extraordinary  degree  to  which 
this  war  is  being  fought  by  machinery.  The  whole  of 
the  Western  Front  in  its  four  hundred  and  thirty 
miles,  from  the  sea  to  the  Alps,  fairly  bristles  with 
machinery  and  literal  engines  of  war  of  every  descrip- 
tion, from  the  trenches  clear  back  to  the  supply  areas 
and  the  bases.  Every  highroad  leading  to  the  Front 
is  as  crowded  with  high-powered  motors  and  camions 
as  a  railroad  roundhouse  is  with  locomotives.    Our 


320  THE  DOCTOR  IN  WAR 

fighting  men  march  by  machinery,  dig  with  machin- 
ery, fly  by  machinery,  and  shoot  by  machinery;  they 
do  everything  by  machinery  except  eat  and  sleep  and 
swear.  So  astoundingly  dependent  have  they  become 
upon  mechanisms  of  every  imaginable  sort,  that  it  is 
actually  proposed  to  utilize  chilled-steel  automatic 
soldiers,  mounted  with  rifles,  whose  fire  can  be 
directed  from  a  safe  distance,  capable  of  rising  up  to 
shoot  and  of  going  down  to  safe  cover,  and  requiring 
neither  food,  nor  clothing,  nor  pay. 

This  means  an  enormous  and  incredibly  lavish 
expenditure  of  ammunition;  more  rounds  can  be 
fired  in  a  minute  by  machinery  than  in  an  hour  by 
hand  as  in  previous  wars.  This  is  not  a  mere  figure  of 
speech ;  in  one  single  offensive  on  the  Somme,  it  was 
stated  in  Parliament  that  the  British  Army  had  fired 
more  shells  and  cartridges  of  all  sorts  than  in  the  en- 
tire Boer  War  I  And  every  army  corps  of  forty  thou- 
sand men  requires  one  single-track  railroad  running 
to  its  full  capacity  day  and  night,  just  to  supply  it 
with  ammunition  alone. 

The  result  has  been  that  instead  of  factories  shut- 
ting down  and  mines  closing  and  trade  stagnating 
and  operatives  being  thrown  out  of  employment, 
there  has  been  an  enormous  stimulation  of  manu- 
facturing activity  along  a  very  large  number  of  lines; 
and  not  merely  the  men  who  have  remained  at  home, 
but  the  women  and  older  children  have  been  fairly 


THE  CIVIL  POPULATION         321 

flooded  with  work  at  wages  beyond  even  their  wildest 
dreams  before  the  war. 

Many  a  soldier's  family,  containing  one  or  more 
children  of  working  age,  has  two  to  three  bread- 
winners now,  instead  of  one  as  before  the  war,  and 
often  each  one  of  them  earning  more  money  per 
week  than  their  father  did,  so  that  with  the  liberal 
separation  allowance  from  the  Government,  they  not 
infrequently  have  from  two  to  three  times  the  income 
that  they  had  in  the  days  of  peace.  The  result  is  that 
the  great  majority  of  the  working  classes,  including 
agricultural  laborers,  who  form  in  England  about 
eighty  per  cent  of  the  total  population,  are  spending 
money  as  they  never  did  in  their  lives  before.  And 
while  naturally  some  of  it  goes  for  feathers  and  cheap 
jewelry  and  taxicab  rides  and  hothouse  luxuries  and 
gaudy  silks  and  satins  and  screaming  plush  furniture, 
the  bulk  of  it  is  going  for  richer  and  more  varied 
meals,  larger  cottages  in  better  neighborhoods,  pianos 
and  organs,  furniture  and  carpets,  yes,  even  pictures 
and  china  and  furs  and  real  diamonds,  and,  as  they 
begin  to  sober  down  from  their  first  delirium  of  ''gold 
fever,"  into  war  bonds  and  savings  banks  and  build- 
ing and  loan  companies. 

Even  their  first  delirious  delight  of  spending,  what 
to  them  was,  in  classic  Johnsonian  phrase,  ''wealth 
beyond  the  dreams  of  avarice,"  though  shocking  and 
simply  scandalizing  to  the  outraged  eye  of  the  moral- 


322  THE  DOCTOR  IN  WAR 

ists  and  preachers  of  economy  of  the  upper  and  middle 
classes,  had  something  pathetic  about  it.  One  woman 
munition  worker,  when  her  first  pay-day  came, 
promptly  "blew  in"  two  thirds  of  her  earnings  for  a 
pair  of  pheasants,  with  hothouse  grapes,  mushrooms, 
and  guava  jelly  for  her  wide-eyed  brood.  Another, 
as  soon  as  she  actually  saw  three  whole  golden  sover- 
eigns lying  in  her  palm  at  once,  to  spend  just  as  she 
liked,  without  fear  of  remonstrance  even  from  her 
husband,  hailed  the  largest  and  most  sumptuous 
public  automobile  that  she  could  find  and  piled  in 
her  whole  tousle-headed,  shabbily  dressed  family  for 
a  ride  round  the  parks.  Another  one  marched  into 
a  fashionable  department  store  and  bought  herself 
a  blazing  and  gorgeously  embroidered  Japanese  ki- 
mono, and  insisted  upon  putting  it  on  over  her  soiled 
and  shabby  working  dress  and  wearing  it  home. 
Each  one  of  them  trying  in  one  reckless,  splendid  mo- 
ment to  gratify  the  ambitions,  the  cravings,  the  unful- 
filled longings  of  a  lifetime,  for  something  supremely 
beautiful  to  the  eye,  soft  to  the  touch,  or  delicious 
to  the  taste.  But  having  once  blown  off  their  accu- 
mulated steam,  their  long-suppressed  yearnings,  in 
Freudian  phrase,  "their  strangulated  emotions,'* 
they  soon  settle  down  to  tamer  and  more  rationally 
balanced  methods  of  spending.  In  Matthew  Arnold's 
phrase  "the  sense  in  them  for  conduct,  the  sense  in 
them  for  beauty,"  reached  an  equilibrium. 


THE  CIVIL  POPULATION  323 

This  was  most  interestingly  and  convincingly 
shown,  in  the  matter  of  foods,  by  actual  scientific 
test  and  experiment.  Naturally  one  of  the  first  indul- 
gences which  the  workers  gave  themselves,  when  the 
Big  Pay  began  to  come  in,  was  in  the  direction  of  their 
favorite  savory  and  attractive  foods,  particularly 
meats,  sausages,  pies,  and  rich  plummy  cakes.  Nu- 
merous headaches  and  bilious  attacks  and  internal 
dissensions  of  sorts  followed  at  first,  but  the  net  result 
was  that  they  got  more  real  food  into  their  systems, 
gained  in  weight,  improved  in  health  and  strength, 
and  did  more  and  better  work  than  they  were  capable 
of  before  on  their  old  poverty  diets.  So  striking  was 
this  last  result  that  the  more  intelligent  owners  and 
employers  of  munition  plants  put  in  well-equipped 
and  attractively  decorated  canteens  or  cafeterias,  in 
which  they  supplied  a  good  variety  of  well-cooked 
and  substantial  foods  at  cost  price,  or  in  some  cases 
actually  a  little  below,  so  as  to  encourage  their  work- 
ers to  feed  themselves  liberally  and  well. 

When  the  committee  of  distinguished  scientists  and 
physicians,  appointed  by  the  English  Government 
to  safeguard  the  health  of  workers  in  munition  plants, 
came  to  study  the  food  problem,  they  decided  to  test 
out  the  self-chosen  diets  of  the  workers  of  both  sexes 
and  various  ages  and  see  whether  they  were  over  or 
under  the  amount  required  for  their  condition  and  the 
work  that  they  were  doing,  and  whether  they  were 


324  THE  DOCTOR  IN  WAR 

reasonably  balanced.  The  tests  were  made  on  quite 
an  extensive  scale  in  a  number  of  different  factories, 
so  as  to  include  all  classes  of  workers  and  conditions 
of  work.  In  some  of  them  a  watch  was  kept  upon  the 
amount  and  kinds  of  food  that  the  operatives  ordered 
in  the  cafeterias;  in  others,  the  consent  of  a  certain 
number  of  the  workers  was  obtained  to  allow  a 
visiting  nurse  to  go  to  their  homes  and  to  take  a  list 
of  the  family  food  purchases  for  a  certain  number  of 
days  or  a  week.  But  the  method  which  was  regarded 
as  freest  from  any  possibilities  of  outside  influence  or 
abnormal  conditions  or  embarrassment  of  any  sort, 
was  the  simple  but  ingenious  one  of  stationing  a  man 
at  the  men's  and  boys'  entrance  to  the  factory,  and  a 
woman  inspector  at  the  women's  and  girls'  entrance, 
and  having  them  offer  every  fifth  or  tenth  worker,  at 
random,  a  dollar  for  their  dinner-pail  and  its  con- 
tents, promising  to  return  the  pail. 

The  contents  of  the  dinner-pail  were  taken  to  one 
of  the  laboratories  of  the  committee  and  their  total 
number  of  calories  or  heat  units  carefully  estimated, 
and  the  proportion  or  balance  of  the  three  or  four 
great  main  food  elements,  proteins,  carbohydrates 
(starches  and  sugars,  fats,  fruit  acids,  and  vegetable 
alkalies)  worked  out.  Then  these  were  compared 
with  similar  findings  drawn  from  the  meals  ordered 
in  the  canteens,  and  the  weekly  food  bills  in  the  house- 
holds.   Much  to  every  one's  surprise  and  also  grati- 


THE  CIVIL  POPULATION         325 

fication,  the  average  results  from  hundreds  of  cases 
was  that  the  diets  adopted  on  their  own  initiative, 
just  simply  guided  by  their  own  unspoiled  appetites, 
by  men  at  heavy  and  at  light  work,  by  women  at 
various  grades  of  occupation,. and  by  boys  and  girls, 
seldom  varied  more  than  ten  or  fifteen  per  cent  from 
the  ideal  amount  required  to  keep  them  in  health  at 
their  age  and  character  of  work !  Which  is  one  of  the 
highest  tributes  to  the  soundness  of  our  instincts  and 
the  good  common  sense  of  average  humanity  that 
has  ever  been  paid. 

^  There  were  exceptions,  of  course,  and  one  of  them 
the  committee,  with  a  saving  sense  of  humor,  thought 
worth  while  chronicling.  It  was  a  boy  of  seventeen, 
who  was  making  some  twenty-six  or  twenty-seven 
shillings  a  week,  to  his  astonished  eye  almost  the 
equivalent  of  as  many  dollars  over  here.  His  esti- 
mated number  of  calories  required,  for  age,  weight, 
and  character  of  work  he  was  doing,  was  thirty-two 
hundred,  while  the  energy  stored  under  the  cover  of 
that  single  pail  represented  no  less  than  eighteen  hun- 
dred calories,  no  trifles  and  knickknacks,  but  good, 
solid,  filling  slabs  of  cold  meat  and  cheese  and  sausage 
and  plum  pudding  and  gingerbread,  with  a  jam  tart 
to  finish  up  with,  whose  puff  paste  walls  were  three 
quarters  of  an  inch  thick ;  which,  if  his  other  two  meals 
were  on  anything  like  as  sumptuous  a  scale,  would 
bring  his  total  intake  up  to  the  magnificent  sum  of 


326  THE  DOCTOR  IN  WAR 

fifty-five  hundred  calories,  nearly  double  his  "text- 
book" requirements.  But  what  are  cold  calculations 
like  these  in  the  happy  days  of  youth?  The  delighted 
youngster  was  probably  having  all  he  could  eat  of 
what  his  soul  most  craved  for  the  first  time  in  his 
young  life,  and  he  was  making  up  for  years  of  under- 
feeding, as  well  as  accumulating  a  margin  for  future 
growth.  He  was  literally  ''blowing  himself,"  —  "do- 
ing himself  extremely  well,"  in  the  quaint  English 
phrase,  —  but  he  would  soon  come  down  to  earth 
again  when  he  had  once  thoroughly  caught  up.  And 
the  committee  specially  noted  that  up  to  the  time  of 
writing  his  health  had  not  suffered  in  the  slightest, 
and  he  was  both  lengthening  and  thickening  at  a 
remarkable  rate,  as  well  as  carrying  his  work  success- 
fully. 

I  talked  with  scores  of  employers,  superintendents, 
and  foremen,  factory  physicians,  and  welfare  work- 
ers, both  men  and  women,  on  my  numerous  visits  to 
the  munition  works  by  the  courtesy  of  the  British 
Foreign  Office,  and  they  were  all  unanimous  in  de- 
claring that,  with,  of  course,  inevitable  exceptions, 
the  vast  mass  of  the  workers,  particularly  the  women 
and  the  children,  had  gained  weight,  improved  in 
nutrition  and  appearance,  and  were  in  markedly 
better  health  as  a  result  of  their  experience  in  the 
factories. 

This  seemed  almost  incredible,  but  it  did  not  take 


THE  CIVIL  POPULATION         327 

long  to  convince  me  by  actual  personal  observation 
that  it  was  an  absolute  fact.  The  secret  of  it  was, 
first  of  all,  the  right  feeling,  sound  common  sense,  and 
patriotic  devotion  of  the  overwhelming  mass  of  the 
workers.  Incidentally,  it  may  be  remarked  that  one 
of  the  finest  things  that  has  come  out  of  this  war  has 
been  the  tremendous  respect  for  both  the  courage 
and  good  feeling  of  the  common  man  in  the  trenches, 
and  the  good  sense  and  public  spirit  of  the  common 
man  and  the  common  woman  at  home  and  in  the 
factories,  inspired  in  every  one  who  has  been  able  to 
observe  either  of  these  situations  at  first  hand.  It  is 
going  to  form  the  basis  of  an  entirely  new  spirit  and 
relationship  between  employer  and  employee,  cap- 
italist and  laborer,  "upper"  and  ''lower."  Every- 
where one  hears  the  hackneyed  but  unreserved  and 
expressive  phrase,  "the  men  —  the  women,  are 
simply  splendid."  Nobody  would  believe  before  this 
trial  by  fire  that  there  was  so  much  dignity,  such 
sound  judgment,  such  inherent  decency  and  kindli- 
ness in  humanity;  and  the  so-called  "lower  classes" 
cordially  return  the  compliment  to  the  upper. 

The  second  great  cause  why  munition  works,  in- 
stead of  breaking  down  the  health  of  women  and  boys 
and  girls,  have  actually  built  it  up,  rests  upon  the 
facts  that,  first  of  all,  most  of  the  war  factories  have 
been  new,  or  so  enormously  expanded  as  to  be  prac- 
tically so,  and  so  had  no  bad  customs  or  traditions 


328  THE  DOCTOR  IN  WAR 

to  contend  with  and  could  be  built  according  to  the 
most  modern  sanitary  and  efficiency  plans.  Second, 
that  they  are  all  under  Government  control  and 
supervision,  constantly  open  and  subject  to  inspec- 
tion, living  in  the  full  light  of  publicity  day  and  night. 
Last  and  not  least,  that  at  the  instance  of  that  great 
democratic  statesman  and  friend  of  the  plain  people, 
Lloyd  George,  the  Government  took  every  possible 
step  from  the  very  beginning,  both  to  safeguard  the 
lives  and  health  of  the  workers  and  to  see  that  all 
controlled  factories  and  other  establishments  were 
planned  and  conducted  upon  the  broadest,  most 
intelligent,  and  up-to-date  industrial  and  hygienic 
lines.  An  admirable  and  capable  committee  on  the 
health  of  munition  workers  was  appointed  in  the 
first  year  of  the  war,  and  studied  out  and  published 
valuable  bulletins  upon  the  various  problems  affect- 
ing the  welfare  of  the  war  workers.  The  more  intelli- 
gent and  successful  owners  and  employers  soon  dis- 
covered that  careful  attention  to  the  health  and 
comfort  of  their  employees  really  paid  and  was  a 
substantial  factor  in  the  earning  of  dividends. 

In  one  way  the  factories  started  under  a  tremen- 
dous handicap,  and  that  was  the  enormous  demand 
and  vital  necessity  of  a  huge  amount  of  output  in  the 
shortest  possible  time.  It  was  a  wonderful  and  most 
crucial  test  and  try-out  of  the  soundness  of  scientific 
and  hygienic  principles  of  productipn.    In  the  first 


THE  CIVIL  POPULATION         329 

weeks  and  months  of  the  war,  when  every  commander 
was  shrieking  for  shells  and  rifles  and  cannon,  all 
rules  were  suspended,  and  the  workers,  in  response 
to  the  frantic  urgings  and  appeals  of  both  the  mili- 
tary authorities  and  their  employers,  worked  liter- 
ally all  day  and  half  the  night,  seven  days  out  of  the 
week,  and  gave  up,  as  a  mark  of  patriotic  devotion, 
even  their  legal  holidays.  The  result  for  the  first  few 
weeks  and  months  was  magnificent.  Factories  sprang 
up  almost  overnight  like  mushrooms.  Utterly  new 
and  unskilled  hands  were  broken  in  to  unfamiliar 
work  within  a  few  weeks.  A  steady  stream  of  arms 
and  ammunition  poured  across  the  Channel.  But 
then  the  strain  began  to  tell.  Men  began  to  go  stale, 
to  try  to  whip  themselves  up  to  the  killing  pace  with 
alcohol,  actually  to  fall  asleep  at  their  machines  or 
their  benches,  and  one  after  another  to  drop  out  and 
not  reappear  next  day,  and  when  messengers  were 
sent  to  urge  them  to  come  back,  they  found  that  they 
had  simply  tumbled  into  bed,  and  slept  for  twenty- 
four,  thirty-six,  forty-eight  hours  at  a  stretch.  What 
was  worse,  the  quality  of  production  was  falling  off. 
**Duds"  were  becoming  more  frequent  among  the 
shells  instead  of  less  so.  The  men  and  women  workers 
were  getting  quarrelsome  among  themselves  and 
difficult  to  deal  with  by  their  superintendents. 

Here  was  the  health  committee's  chance.    They 
came  forward  with  what  at  first  sight  was  fairly 


330  THE  DOCTOR  IN  WAR 

scoffed  at  as  a  hopelessly  heroic  remedy,  namely, 
cutting  down  the  hours  of  work  to  nine  or  less  a  day, 
restoring  the  Saturday  half -holiday,  abolishing  Sun- 
day work,  and  discouraging  overtime  work  as  much 
as  possible.  The  cure  looked  simply  suicidal  to  most 
employers,  but  the  situation  was  desperate,  and  a 
few  of  them  were  intelligent  or  reckless  enough  to 
give  it  a  trial.  To  their  intense  astonishment  it 
worked,  just  as  we  doctors  had  been  telling  them  it 
would  for  nearly  twenty  years  past.  Men  and  women 
who  were  working  twelve,  thirteen,  and  fourteen 
hours  a  day,  either  on  piece-work  or  on  output  which 
could  be  easily  counted  and  estimated,  such  as  shell 
fuses,  for  instance,  on  being  cut  down  to  eight  and 
nine  hours  a  day,  not  only  did  not  lose  ground  on 
their  output,  but  actually  increased  it. 

So  that  England's  population  is  doing  its  war- 
work  under  almost  ideal  hygienic  conditions  and 
hours,  and  fairly  thriving  on  it,  as  evidenced  by  the 
significant  fact  that  both  the  death-rate  and  disease- 
rate  of  the  entire  civilian  population,  as  well  as  the 
infant-mortality,  have  during  this  war  reached  the 
lowest  levels  on  record  in  history j  and  the  total 
population  of  England  is  slightly  hut  distinctly  in- 
creasing year  by  year,  in  spite  of  her  terrific  losses 
in  the  field! 


XIX 

GUARDING  THE  HEALTH  OF  THE  NAVY 


M 


AN  is  by  nature  an  amphibious  animal.   The 
famous  old  sentimental  ballad,  — 

"Sigh  no  more,  ladies,  sigh  no  more, 
Men  were  deceivers  ever. 
One  foot  in  sea  and  one  on  shore, 
To  one  thing  constant  never,"  —  . 

however  painfully  uncomplimentary  it  might  be  in 
its  first  and  last  lines,  is  absolutely  and  historically 
truthful  in  its  third.  In  fact,  his  inconstancy  might 
be  stated  in  even  stronger  terms  nowadays,  not 
merely  double-faced,  but  triple-faced,  as  judging  by 
the  success  of  his  recent  invasion  of  still  another  ele- 
ment, the  air,  he  is  likely  soon  to  find  himself  equally 
at  home  in  all  three. 

At  present  and  by  comparatively  ancient  tradi- 
tion, we  have  come  to  regard  ourselves  as  land  ani- 
mals, and  having  conquered  a  partial  and  precarious 
footing  upon  the  cruel  and  treacherous  sea  only  at 
great  venture  and  peril.  But  as  a  matter  of  historic 
and  geologic  fact,  we  were  originally  hatched  just 
about  where  the  old  ballad  describes  us  as  still  stand- 
ing, where  sea  and  land  meet,  and  we  followed  the 
sea  for  thousands  of  aeons  before  we  finally  turned 


332  THE  DOCTOR  IN  WAR 

our  swim  bladders  into  lungs  and  our  fins  into  feet 
and  clambered  up  on  to  the  mud-flats  for  keeps.  Then 
mark  how  history  repeats  itself.  No  sooner  did  we, 
in  the  dawn  of  that  day  before  yesterday  which  we 
call  historic  times,  succeed  in  conquering  the  waves 
and  breaking  through  the  encircling  barrier  of  "the 
white  and  wailing  fringe  of  sea»"  by  the  achievement 
of  what  Ruskin  describes  as  man's  greatest  and  most 
momentous  single  invention,  the  ship,  a  little  section 
of  dry  land,  which  would  carry  its  shell-full  of  pre- 
cious air  skimming  across  the  surface  of  the  deep, 
than  we  began  to  live  upon  the  sea  again  and  to  build 
our  towns  and  our  marts,  our  fortresses  and  our 
palaces,  our  great  cities  and  the  capitals  of  our  world 
empires,  upon  its  salty  marge,  where  their  feet  could 
be  washed  by  its  ebbing  and  flowing  tides. 

One  curious  illusion,  however,  still  clings  to  us  as 
the  result  of  our  long,  long  dry  spell  between  the 
salamander  stage  and  the  ship,  and  that  is,  that  life 
upon  the  sea  is  dangerous  and  uncertain  to  the  high- 
est degree  as  contrasted  with  the  peaceful  safety  of 
life  on  shore.  All  our  litanies  are  full  of  prayers  *^for 
those  in  peril  on  the  sea."  Most  of  the  adjectives 
which  are  applied  to  "the  great  world  mother, 
mother  and  lover  of  men,  the  sea,"  are  harsh  and 
unkindly  ones,  "cruel,"  "hungry,"  "treacherous," 
"merciless,"  "angry,"  "devouring,"  "engulfing." 
Kipling's  Norseman's  wife  cries  out  to  her  husband  — 


THE  HEALTH  OF  THE  NAVY     333 

"  What  is  a  woman  that  you  should  forsake  her 
To  go  with  the  old,  gray  widow-maker?" 

And  his  splendid  trumpet  song  of  ''England's  Dead" 
begins  — 

"We  have  fed  our  sea  for  a  thousand  years, 
But  she  calls  to  us,  still  unfed; 
Though  there 's  never  a  wave  of  all  her  waves 
But  marks  our  English  dead." 

As  a  matter  of  cold  statistical  fact,  fewer  lives  are 
lost  at  sea  by  hurricane,  by  shipwreck,  by  fire,  by 
hidden  reef  or  uncharted  rock,  by  all  the  perils  of  the 
deep,  than  are  swept  away  by  any  one  of  a  dozen  of 
our  minor  diseases  and  pestilences.  The  sailor  ranks 
high  in  the  tables  of  longevity,  only  a  little  way  below 
the  farmer  and  the  clergyman;  he  is  in  far  more 
danger  from  fire-water  than  he  is  from  sea- water,  and 
is  an  excellent  life  risk  if  he  only  keeps  away  from  the 
former.  On  the  face  of  the  figures,  following  the  sea 
is  one  of  the  safest  and  healthiest  of  occupations, 
while  the  actual  mortality  of  all  those  who  go  down 
to  the  sea  in  ships,  whether  as  passengers  or  seamen, 
is  far  lower  than  that  of  those  who  remain  on  shore. 

In  fact,  the  attitude  of  the  ancient  sailor-man 
chantey  — 

"The  wind  it  blew  a  hurricane, 

The  sea  was  mountains  rolling, 

When  Billy  Buntline  turned  his  quid 

And  said  to  Billy  Bowling, 
*  Old  Boreas  is  a-comin'  Bill ; 

Don't  you  hear  him  roar  now? 

And  don't  you  pity  all  poor  folks, 

That  are  upon  the  shore  now?  '  " 


334  THE  DOCTOR  IN  WAR 

is  far  more  rational  and  in  accord  with  the  facts  of 
the  case  than  the  traditional  sentimental  melancholy 
of  the  "men  must  work  and  women  must  weep*' 
order. 

Of  course,  there  are  certain  cold-blooded  deduc- 
tions which  must  be  made  from  these  apparent  re- 
sults, such  as  that  sailors  consist  exclusively  of  men, 
the  great  majority  of  whom  are  in  the  prime  of  life, 
and  of  a  considerably  higher  degree  of  toughness  and 
resisting  power  than  the  average,  otherwise  they 
would  have  been  weeded  out  and  discouraged  by  the 
hardships  which  they  have  to  meet.  And  as  regards 
the  floating  population  having  a  lower  death-rate 
than  the  shore  one,  the  suggestion  of  the  well-known 
paradox  about  bed  being  the  most  dangerous  place 
in  the  world  because  so  many  people  die  there,  must 
also  be  borne  in  mind.  But  when  all  the  deductions 
have  been  made,  the  single  fact  still  remains,  that 
we  are  actually  safer  afloat  than  ashore,  and  the  risks 
and  dangers  of  this  present  war  are  a  striking  illus- 
tration of  the  general  rule. 

On  the  face  of  the  figures  the  navy  of  any  of  the 
first-class  powers  is  one  of  the  healthiest  places  in  the 
world,  a  regular  floating  health  resort.  The  death- 
rate  in  the  British  Navy,  for  instance,  from  all  causes 
for  the  ten  years  before  the  war  had  averaged  less 
than  four  per  thousand  per  year,  and  in  1913  had 
actually  fallen  to  3.24  per  thousand,  a  good  average 


THE  HEALTH  OF  THE  NAVY     335 

death-rate  on  shore  being  from  fourteen  to  sixteen 
per  thousand,  while  our  own  navy  is  only  a  fraction 
of  a  per  cent  behind  this.  Of  course,  it  must  be  re- 
membered that  the  Navy  is  manned  entirely  by  boys 
and  men  of  from  fifteen  to  forty-five,  the  vast  ma- 
jority being  under  thirty,  in  the  very  prime  of  life, 
the  literal  Golden  Age  of  health;  that  they  are  se- 
lected after  a  careful  physical  examination  and  given 
a  thorough  try-out  during  the  first  six  months  of 
their  service,  to  weed  out  and  reject  any  who  are  not 
up  to  the  standard,  or  cannot  be  built  up  to  it. 

But  even  allowing  for  all  this,  their  death-rate  and 
disease-rate  afloat  is  only  about  half  that  of  men  and 
boys  of  the  same  ages  on  shore.  And  as  the  personnel 
of  the  Navy  represents  a  thoroughly  average  sample 
of  the  total  community  ashore,  if  anything  a  some- 
what larger  proportion  of  its  force  being  drawn  from 
the  more  poorly  paid  working  classes  than  would  be 
found  in  an  average  town  or  county,  it  is  fair  to  con- 
clude that  at  least  three  fourths  of  the  boys  of  all 
classes  on  shore  could  be  brought  up  to  the  same 
standards  of  health  if  they  were  caught  young  and 
given  the  same  treatment. 

Indeed,  the  Navy  is  a  standing  and  shining  exam- 
ple of  what  could  be  done  to  improve  our  national 
health  and  vigor  by  giving  intelligent  attention  to  the 
matter.  Its  splendid  results  are  the  more  remarkable 
because  they  have  been  achieved  under  quite  unfa- 


336  THE  DOCTOR  IN  WAR 

vorable  circumstances,  in  many  respects,  and  in  a 
very  narrow  and  limited  environment.  A  warship, 
even  of  the  hugest,  is  an  extremely  cramped  and  lim- 
ited sort  of  a  place  between  decks.  Its  star  or  parlor 
boarders  are,  of  course,  the  engines  and  their  coal. 
Its  second-floor  front  tenants  are  the  guns  and  their 
ammunition,  while  the  men  are  third-floor  back  and 
hall-bedroom  boarders,  and  have  to  tuck  their  mess- 
rooms  and  sleeping-spaces  into  whatever  corners  and 
gaps  are  left. 

This  means  that  the  problems  both  of  ventilating 
and  lighting  the  sleeping-places  of  a  battleship*s 
company  have  always  been  difficult  ones.  In  fact, 
only  in  the  more  modem  ships  since  the  introduc- 
tion of  electric  lighting  and  of  special  fan  systems  of 
forced  ventilation,  have  these  problems  been  at  all 
adequately  solved.  Further  than  this,  the  difficulty 
of  obtaining  regular  supplies  of  perishable  food,  such 
as  fresh  vegetables,  fresh  meat,  and  fresh  fish,  has 
always  been  great,  until,  in  the  more  recent  ships,  it 
has  been  overcome  by  the  introduction  of  ice  or  of 
refrigerating  plants. 

Then,  too,  voyages  were  long  and  monotonous, 
there  was  nothing  approaching  society  on  board,  and 
very  little  in  the  way  of  entertainment  or  intelligent 
amusement.  The  men  got  stale  and  restless,  and  when 
finally  they  were  given  shore  leave  they  were  disposed 
to  try  and  make  up  for  lost  time  and  "take  in"  the 


THE  HEALTH  OF  THE  NAVY     337 

whole  town  and  its  excitements  inside  of  forty-eight 
hours,  with  the  result  that  they  frequently  came  back 
with  "a  head  like  a  concertina,"  a  beautifully  pickled 
stomach,  and  a  prospect  of  venereal  disease. 

It  is  most  interesting  to  watch  how,  as  these  special 
difficulties  have  been  faced  and  conquered  one  after 
another,  the  death-rate  of  the  Navy  has  steadily  gone 
down  year  after  year  from  about  fifteen  per  thousand, 
fifty  years  ago,  to  eight,  thirty  years  since,  and  finally 
down  to  the  present  three.  There  has  been  no  magic 
about  the  process,  simply  good,  common-sense,  hygi- 
enic methods.  First  of  all,  improving  the  food  and 
making  it  not  merely  sound  and  nutritious,  but  inter- 
esting and  attractive  to  the  men,  especially  by  means 
of  fresh  vegetables,  fruits,  and  sugars.  This  not  only 
greatly  improved  the  health  and  comfort  of  the  men 
and  kept  them  better  satisfied  with  the  monotony  of 
their  life  afloat,  but  it  also  greatly  diminished  their 
tendency  to  accumulate  "a  thirst"  or  craving  for 
one  tremendous  drunk  and  spree  whenever  they 
reached  the  first  port  and  got  shore  leave. 

Then  the  electric  light,  in  place  of  two  or  three 
smoky  oil  lamps,  which  could  do  little  more  than 
emphasize  the  darkness  all  round  the  walls,  by  throw- 
ing a  flood  of  illumination  into  every  corner  of  the 
mess-rooms  has  made  it  possible  for  the  seamen  to 
read  and  write  and  sketch  or  carve  or  play  games 
with  ease  and  comfort,  thus  greatly  diminishing  the 


338  THE  DOCTOR  IN  WAR 

monotony  of  the  voyage  as  well  as  improving  their 
intelligence  and  broadening  their  interests. 

One  of  the  most  powerful  factors  in  giving  the  Navy 
such  a  splendid  health  record,  a  close  second  to  if  not 
on  a  level  with  the  improvements  of  food  and  ven- 
tilation, has  been  our  increasing  power  of  barring  out 
infections.  It  is  estimated  that  at  least  two  thirds  of 
all  deaths  on  shore  are  due  directly  or  indirectly  to 
infectious  disease  of  some  sort.  And  the  very  isola- 
tion of  the  Navy,  which  deprives  it  of  so  many  oppor- 
tunities and  pleasures,  has  this  redeeming  feature, 
that  it  cuts  out  at  the  same  time  three  fourths  of  its 
risk  of  infectious  disease  if  pains  are  taken  to  make 
the  most  of  this  advantage. 

Most  of  the  boys,  when  they  enter  the  Navy,  have 
either  passed  through  the  diseases  of  childhood  in 
earlier  years,  or  have  caught  them  in  the  training 
depots  and  schools  on  shore,  just  as  the  recruits  do 
in  the  training-camps,  and  thus  have  become  "salted  " 
against  most  of  the  minor  infections.  Typhoid  they 
are  comparatively  safe  from,  because  most  of  their 
drinking-water  is  taken  from  carefully  inspected 
sources,  and  their  food  has  been  rigidly  tested  before 
purchasing  and  is  not  subject  to  infection  by  flies  or 
dust,  or  by  ''Typhoid  Marys,"  or  other  polluted 
handling.  There  were  only  one  hundred  and  twenty- 
three  cases  in  the  whole  English  Navy  of  125,000  men 
in  191 3,  or  one  case  per  thousand  men.   Pneumonia 


THE  HEALTH  OF  THE  NAVY     339 

and  bronchitis  they  are  not  so  completely  protected 
against,  but  as  the  majority  of  these  are  likely  to 
follow  in  the  wake  of  common  colds,  influenzas,  and 
epidemics  of  tonsillitis,  and  their  chances  of  catching 
these  are  less  than  half  those  of  the  shore  population, 
for  obvious  reasons,  their  proportion  of  the  deaths 
is  far  below  that  among  landsmen.  In  the  year  1913, 
for  instance,  only  one  per  cent  of  the  entire  personnel 
of  the  British  Fleet  developed  influenza,  and  the 
average  for  five  years  preceding  was  only  about  one 
and  a  half  per  cent. 

How  have  the  risks  and  perils  of  the  Great  World 
War  affected  the  conditions  and  immunities  of  the 
Navy?  In  view  of  the  tremendously  prominent  and 
unspeakably  valuable  and  important  part  which  the 
Navy  has  played  in  this  war,  flung  into  it  in  its  full 
force  from  the  very  first  day  of  hostilities  and  kept 
incessantly  at  work  or  on  guard  for  every  moment 
since,  it  would  be  only  natural  to  expect  a  correspond- 
ingly huge  increase  of  its  risks  and  the  rise  of  its 
death-rate.  Moreover,  the  risks  of  actual  battle  in 
modern  warships  have  in  some  ways  been  increased 
in  the  most  dramatic  and  appalling  fashion. 

In  the  days  of  wooden  ships  and  solid  cannon  balls, 
the  gun-decks  would  be  turned  into  shambles  and 
the  hulls  riddled  with  shot,  until  finally  they  went 
down  with  colors  flying,  but  there  was  usually  time 
for  most  of  the  crew,  who  were  nearly  all  up  on  the 


340  THE  DOCTOR  IN  WAR 

fighting  decks,  to  take  to  their  boats  and  even  to 
carry  off  a  considerable  proportion  of  the  wounded. 
But  the  modern  armor-plated  and  high-engined 
battleship,  which  is  a  marvelous  instrument  of 
destruction  and  a  literal  floating  fortress,  —  as  long 
as  she  floats,  —  when  she  does  make  up  her  mind  to 
go  down,  founders  with  appalling  suddenness.  One 
single  fifteen-inch  shell  may  sink  her  almost  as  sud- 
denly as  a  rifle  bullet  would  a  floating  bottle.  And  as 
her  entire  ship's  company  is  under  cover,  many  of 
them  in  the  engine-room  and  at  the  munition  hoists 
or  in  the  sick-bay,  three  or  four  stories  under  water, 
their  chances  for  escape  are  pitifully  small. 

Kipling  has  voiced  the  deep-seated  reluctance  of 
the  old-fashioned  sailor-man  against  "going  to  sea 
in  the  works  of  an  eight-day  clock,"  and  in  one  sense 
the  old  salt's  objection  is  thoroughly  justified.  On 
my  visit  to  the  English  Fleet,  for  instance,  I  met  a 
young  captain,  a  handsome,  clear-eyed,  almost  boy- 
ish-looking young  ofBcer,  who  was  the  sole  survivor  of 
an  entire  ship's  crew  and  company  of  thirteen  hundred 
men.  It  was  in  the  Battle  of  Jutland,  and  he  had 
pluckily  climbed  up  under  a  hail  of  fire  into  the  high- 
est fighting  top,  with  his  glasses,  in  order  to  get  a 
clearer  view  of  the  enemy's  ships  through  the  North 
Sea  smother  and  spray.  A  single  half- ton  shell  struck 
her  at  the  water  line  and  exploded  in  her  engine-room, 
and  she  went  down  within  a  hundred  seconds.   As 


THE  HEALTH  OF  THE  NAVY     341 

she  went  down,  she  heeled  over  suddenly  to  port, 
and  he  was  flung  out  of  the  fighting  top  as  from  a 
catapult,  and  landed  in  the  sea  a  hundred  and  fifty 
feet  away  from  her  side  and  clear  of  her  vortex.  By 
great  good  luck  he  was  unhurt  by  the  fall,  and  when 
he  came  up  to  the  surface  found  himself  within  a 
hundred  yards  of  a  destroyer,  swam  to  her  side,  and 
was  taken  on  board.  And  as  the  Germans  were  fol- 
lowing their  usual  tactics  of  firing  upon  the  wounded 
in  the  water  and  upon  any  boats  that  put  out  to  their 
rescue,  he  was  the  only  one  who  lived  to  tell  the  tale. 

An  additional  horror  has  been  added  to  this  grim 
risk  of  modern  naval  battle  by  the  fact  that  the  Ger- 
mans have  burned  up  all  the  moral  codes  and  funda- 
mental decencies,  and  not  only  fire  upon  all  boats 
put  out  to  rescue  the  wounded,  but  send  up  their 
submarines  to  torpedo  the  ship  which  checks  her 
headway  for  this  purpose.  Two  thirds  of  the  first 
English  and  French  vessels  which  the  Huns  succeeded 
in  sinking  were  caught  in  this  dastardly  way,  and  the 
Admiralty  was  compelled  to  issue  an  order  forbidding 
the  lowering  of  boats  for  the  rescue  of  the  wounded, 
on  account  of  the  serious  risk  to  the  much  larger 
numbers  on  board  the  ship. 

In  some  instances  the  Huns  actually  fired  upon  the 
English  boats  which  were  putting  out  to  rescue  Ger- 
man wounded  struggling  in  the  water.  If  they  could 
get  two  English  lives  by  the  sacrifice  of  one  of  their 


342  THE  DOCTOR  IN  WAR 

own,  the  transaction  showed  a  clear  profit,  in  their 
code  of  morals. 

Another  somewhat  unexpected  result  of  the  tre- 
mendous piercing  and  explosive  power  of  the  big 
shells,  combined  with  this  new  sea-wolf  code,  has 
been  the  complete  reversal  of  the  usual  proportions 
which  obtain  between  killed  and  wounded  in  land 
battles.  The  one  ratio  in  the  present  war  which  has 
not  changed  is  that  between  killed  and  wounded, 
which  has  remained  curiously  constant  at  between 
four  and  five  to  one  for  the  last  two  hundred  years; 
that  is  to  say,  out  of  every  hundred  casualties  twenty 
will  be  deaths,  twenty  rather  serious  wounds,  and 
the  remainder,  light  wounds.  In  a  few  battles  in  the 
earlier  months  of  the  war,  before  methods  of  protec- 
tion against  modem  artillery  had  been  properly  de- 
veloped, the  proportion  of  killed  outright  ran  some- 
what higher,  in  some  instances  up  to  thirty  and  even 
fifty  per  cent  of  the  total  casualties,  but  of  late  the 
tendency  has  been  strongly  in  the  other  direction, 
and  in  the  engagements  of  the  past  summer,  in  the 
British  Army,  for  instance,  the  proportion  fell  as  low 
as  only  one  death  in  six  and  even  one  in  ten  casualties. 

The  situation  in  the  Navy  is  almost  exactly  the 
reverse  of  this,  and  in  its  only  two  or  three  really 
important  engagements  of  the  war,  while,  of  course, 
it  is  not  permitted  to  publish  the  exact  figures,  the 
number  of  wounded  was  barely  one  tenth  that  of  the 


THE  HEALTH  OF  THE  NAVY     343 

dead.  A  **Jacky's"  risk,  therefore,  is  almost  literally 
**neck  or  nothing."  He  either  escapes  scot-free  or 
goes  to  the  bottom,  nine  times  out  of  ten. 

This  grimly  simplifies  the  problem  of  caring  for  the 
wounded  and  makes  hospital  ships  far  less  necessary 
than  was  anticipated,  as  each  battleship  that  remains 
afloat  after  an  action  is  pretty  nearly  able  to  take 
care  of  her  own  wounded  until  she  can  carry  them 
into  port  herself,  or  traUvsfer  them  to  a  light  armored 
cruiser,  which  will  act  as  collecting  ambulance  for 
the  entire  fleet. 

Each  battleship  has  a  well-appointed  and  equipped 
sick-bay  or  small  hospital  ward,  with  from  ten  to 
fifty  beds,  according  to  her  rating  and  the  size  of 
her  company.  There  is  an  operating-room,  an  X-ray 
equipment,  steam  sterilizers,  and  everything  which 
is  needed  to  take  care  of  all  but  the  most  complicated 
cases  of  surgery.  Everything  is  spotlessly  clean,  and 
there  is  a  highly  competent  staff  of  surgeons  and 
assistants  and  hospital  attendants  on  board  each  of 
the  larger  ships,  but  the  quarters  are  necessarily 
cramped  and  fearfully  noisy  for  men  whose  pain 
keeps  them  awake. 

Moreover,  even  the  biggest  dreadnoughts  and 
cruisers,  though  they  ride  the  waves  nobly,  are  not 
exactly  transatlantic  ferries,  especially  in  rough 
weather,  while  the  destroyers  are  just  about  as  easy 
to  ride  as  bucking  broncos  and  little  better  than 


344  THE  DOCTOR  IN  WAR 

jumping  hells  for  men  with  deep  wounds  or  broken 
bones.  Their  hearts  are  literally  too  big  for  their 
bodies,  and  the  whizzing  speed  at  which  they  are 
driven  by  their  tremendously  powerful  engines  gives 
them  no  time  to  ride  over  the  waves,  but  sends  them 
slap  through  them,  like  flying  thunderbolts,  or  even 
scooting  from  one  wave  crest  to  another  like  a  skip- 
ping stone  playing  ducks  and  drakes.  It  is  a  never- 
ending  marvel  how  they  manage  to  keep  afloat  at  all 
in  rough  weather;  they  come  heaving  up  out  of  the 
sea  smother  like  a  huge  flying  dragon  swattering 
along  the  surface  of  the  water;  by  the  time  you  have 
made  out  what  they  are,  they  are  abreast  of  or  on 
top  of  you,  and  you  duck  to  let  them  go  over  your 
head,  and  before  you  can  catch  your  breath  and  turn 
round,  they  are  hull  down  and  out  of  sight  on  the 
horizon  behind  you,  leaving  nothing  but  a  trail  of 
smudgy  smoke  and  a  whining  roar  like  a  big  shell,  to 
prove  that  they  have  ever  been  there !  They  are  like 
flying  expresses  tearing  along  the  surface  of  the  sea, 
and  you  would  n't  be  surprised  at  any  moment  to  see 
them  rise  right  up  into  the  air  like  a  big  airplane  — 
all  that  seems  necessary  would  be  a  feather  duster 
on  each  side  of  them.  In  rough  weather  their  crews 
have  to  be  strapped  into  their  bunks  at  night  to  keep 
from  being  hurled  out  on  to  the  floor,  and  for  wounded 
men  they  are  simply  impossible. 

The  proposed  plan  and  normal  method  of  handling 


THE  HEALTH  OF  THE  NAVY     345 

the  wounded  in  the  Navy  was  for  each  fleet  to  be 
accompanied  by  its  hospital  ship  or  ships  following 
at  a  safe  distance  behind  it  and  steaming  rapidly  up 
after  an  action  to  take  on  board  the  wounded  from 
the  different  ships.  But  this  plan  has  been  seriously 
interfered  with  by  the  new  conditions.  First,  because 
the  hospital  ships  are  not  fast  enough  to  keep  up  with 

the  battle  fleet,  which  has  to  steam  like in  order 

to  try  and  catch  up  with  the  Germans  before  they 
can  get  back  to  port.  Second,  because,  in  order  to 
transfer  wounded,  a  battleship  is  obliged  to  heave  to, 
and  this  exposes  her  to  torpedo  attacks  by  subma- 
rines. Third,  the  transfer  of  wounded  from  huge  float- 
ing fortresses  like  modern  battleships  is  only  possible 
in  the  calmest  of  weather,  and  this  practically  never 
happens  in  the  North  Sea.  It  furnishes  a  wide  variety 
of  weathers,  but  each  is  usually  rather  worse  than 
the  one  before  it.  Whenever  it  does  n't  blow,  there  is 
fog,  and  whenever  there  is  n't  fog,  it  is  blowing  at 
least  half  a  gale. 

In  order  to  meet  this  situation,  it  has  been  sug- 
gested that  small,  swift  vessels  of  about  five  or  six 
hundred  tons,  registered  and  protected  according  to 
the  Geneva  Convention,  should  be  specially  equipped 
to  pick  up  rapidly  survivors  from  the  sea  or  to  hang 
alongside  moving  battleships^and  catch  the  wounded 
as  they  are  slung  overboard. 

But  even  these  would  still  be  subject  to  the  last 


346  THE  DOCTOR  IN  WAR 

and  greatest  difficulty  of  all,  and  that  is,  the  habit  of 
the  Hun  submarine  sea-snakes,  of  torpedoing  and 
sinking  every  hospital  ship  that  they  can  reach  on 
one  lying  pretext  or  another. 

But  in  actual  practice  so  far  no  serious  difficulty 
has  arisen,  party  because  the  German  warships,  most 
judiciously,  have  kept  so  close  in  the  shelter  of  their 
own  ports,  where  most  of  them  are  reported  to  be 
roofed  over  with  a  sort  of  floating  boat-house,  which 
keeps  out  drafts  and  the  damp  air  and  prevents  de- 
terioration of  their  equipment  and  crew.  Partly  be- 
cause they  make  such  excellent  time  back  to  their 
kennels  whenever  they^  do  prowl  cautiously  out  and 
happen  to  run  into  something,  that  there  has  been 
little  difficulty  in  every  battleship  which  has  been 
lucky  enough  to  catch  sight  of  a  German  getting 
back  to  where  it  is  safe  to  transfer  the  wounded  to  a 
hospital  ship,  or  even  to  land  them  at  one  of  the 
home  ports. 

These  hospital  ships  are  beautifully  equipped  with 
every  modern  medical  and  surgical  appliance,  with  a 
full  surgical  staff  and  splendid  corps  of  women  nurses 
supplied  by  Queen  Alexandra's  Royal  Naval  Nursing 
Service.  They  are  literally  floating  hospitals  in  the 
best  sense  of  the  term,  with  cots  for  from  two  hun- 
dred to  three  hundred  cases,  divided  into  wards  on 
the  different  decks,  and  with  perfect  lighting  and 
ventilation  everywhere.   The  wounded  I  saw  on  the 


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THE  HEALTH  OF  THE  NAVY     347 

two  which  I  visited  were  Hterally  in  clover  and  as 
comfortable  and  well  cared  for  as  if  in  a  modern  city 
hospital  on  shore.  But  as  the  Navy  surgeons  who 
accompanied  me  pointed  out,  for  the  reasons  already 
mentioned  the  hospital  ships  were  practically  com- 
pelled to  remain  at  anchor  most  of  the  time,  and  it 
was  only  a  matter  of  a  few  miles  farther  steam- 
ing to  discharge  the  wounded  men  at  the  landing- 
stage,  where  the  ambulances  were  waiting  to  carry 
them  up  to  the  hospitals  on  shore.  And  as  the  sum 
paid  for  the  charter  of  these  commodious  and  beau- 
tiful hospital  ships  was  in  the  neighborhood  of  a 
thousand  dollars  a  day,  a  good  hospital  completely 
equipped,  convenient  to  the  landing-stage,  with  the 
same  capacity  as  the  ship,  could  be  built  for  about  the 
cost  of  six  months  of  her  charter.  So  that  it  looks  as 
if  in  future  wars  the  naval  hospital  ship  will  probably 
be  replaced  by  much  smaller,  swift  vessels  acting  as 
marine  ambulances  and  picking  up  the  wounded, 
either  from  the  water  or  from  the  battleships,  and 
making  a  flying  trip  back  with  them  to  the  nearest 
port  where  there  is  a  hospital  train  or  a  port  hospital. 
Another  somewhat  unexpected  thing  about  the 
wounded  in  the  sea-fighting  of  this  war  was,  that 
although  the  shell  splinters  with  which  they  were 
struck  had  had  no  opportunity  to  bury  themselves  in 
the  ground  before  exploding  and  so  come  up  loaded 
with  all  the  germs  and  filth  of  manure  and  fertilizer, 


348  THE  DOCTOR  IN  WAR 

nevertheless,  almost  every  one  of  them  was  infected, 
although,  of  course,  not  nearly  so  heavily  and  viru- 
lently as  those  of  the  land  battles. 

Part  of  this  might  be  accounted  for  by  the  fact  that 
some  of  the  wounds  were  made  by  splinters  from  the 
deck  or  sides  or  furniture  and  equipment  of  the 
ships  themselves,  which,  of  course,  even  with  the  most 
perpetual  scrubbing  and  spotless  cleanliness,  could 
hardly  be  kept  aseptic,  what  with  grease  and  grime, 
coal  dust,  and  human  traffic.  But  it  also  supports 
the  impression,  which  is  quite  general  among  Army 
surgeons,  that  the  fragments  and  filling  of  modern 
explosive  projectiles  are  by  no  means  aseptic,  even 
when  they  burst  in  the  air  and  have  no  opportunity 
to  touch  the  ground  at  all  before  exploding. 

I  made  careful  inquiries  at  a  number  of  the  big 
munition  works  which  I  visited,  as  to  the  nature  and 
handling  of  the  "filler"  which  is  put  into  the  shrapnel 
shells  to  pack  the  bullets  into  a  solid  mass,  and  found 
that  it  was  composed  largely  of  a  gelatine-like  sub- 
stance, which  was  liquefied  by  heating  and  then 
poured  in  to  fill  up  the  little  spaces  between  the  bul- 
lets, much  as  syrup  is  poured  into  a  jar  of  raspberries 
or  strawberries  in  canning.  And  as  gelatine  is  made 
out  of  the  hoofs  and  bones  of  horses  and  cattle,  with- 
out any  attempt  to  render  these  sterile,  except  for  the 
finer  grades  which  are  to  be  used  for  food  purposes, 
and  as  the  heat  applied  in  melting  was  not  at  all  suffi- 


THE  HEALTH  OF  THE  NAVY     349 

cient  to  destroy  any  germs  which  it  might  contain, 
it  is  possible  that  this  might  have  been  our  source  of 
the  practically  universal  infection  of  all  war  wounds 
from  explosive  projectiles.  Some  of  the  larger  shells 
were  filled  up  with  irregular  cubical  fragments  of 
scrap  iron  shoveled  right  up  from  the  earthen  floor 
of  the  furnaces  and  foundries,  and  this,  of  course, 
might  easily  mean  another  source  of  infection. 

Several  of  the  military  eye  surgeons,  both  Navy 
and  Army,  expressed  their  surprise  that  so  many 
wounds  of  the  eyes  with  which  they  had  to  deal  w^ere 
infected  and  suppurated,  in  spite  of  everything  that 
could  be  done.  And  this,  too,  in  a  number  of  cases 
where  the  eyes  had  been  wounded  by  fragments  of 
shrapnel  which  were  known  to  have  burst  in  the  air. 

The  most  singular  splinter  driven  into  an  eye  by 
the  explosion  of  a  shell  was  one  reported  to  me  by 
one  of  my  Navy  surgeon  friends  in  the  Home  Fleet. 
The  eye  was  so  hopelessly  torn  and  lacerated  that  it 
had  to  be  removed,  and  on  cutting  it  open  to  find  the 
splinter  which  had  destroyed  it,  my  friend  was  as- 
tonished to  discover,  deeply  embedded  in  the  eye- 
ball, a,  fragment  of  bone  from  a  human  skull.  It  was 
nearly  three  quarters  of  an  inch  square,  large  enough 
to  be  perfectly  recognizable  as  a  portion  of  the  vault 
of  the  skull,  and  on  inquiry  it  was  found  that  the 
wounded  man's  mate  at  the  gun  had  had  his  head 
blown  to  pieces  by  the  same  shell! 


350  THE  DOCTOR  IN  WAR 

Even  for  all  the  difficulties  which  Hun  brutality 
has  created  in  the  way  of  caring  for  the  wounded,  the 
same  splendid  results  were  obtained  as  in  the  Casu- 
alty Clearing-Stations  and  Base  Hospitals  on  dry 
land ;  that  is  to  say,  a  recovery  rate  of  between  ninety 
and  ninety-five  per  cent  and  a  hospital  sojourn  of  an 
average  of  less  than  three  weeks  before  the  wounded 
were  discharged  as  recovered,  eighty  per  cent  of  them 
to  return  to  active  service. 

Nothing  could  be  more  thorough  and  admirable 
than  the  system  which  has  been  planned  and  installed 
for  the  care  of  the  wounded  from  the  fleet  when  they 
are  once  landed.  Hospitals  were  built  both  in  the 
towns  nearest  to  the  several  rendezvous  of  the  great 
fleets,  and  beds  were  provided  in  almost  every  town 
of  any  size  on  or  near  the  eastern  coast  of  England, 
this  being  the  only  one  which  German  warships  other 
than  submarines  had  any  possible  chance  of  reaching. 
Then  ambulance  units  were  organized  in  or  near 
practically  every  tiniest  harbor  or  even  fishing  village 
which  possessed  a  landing-stage  or  pier  and  where 
there  was  a  possibility  of  wounded  men  being  landed 
after  an  action.  These  were  connected  by  telephone 
and  motor  with  the  nearest  city  hospital,  so  that  any 
ship's  launch,  with  a  cargo  of  wounded,  could  strike 
the  English  coast  at  any  point  at  random  and  upon 
wireless  or  rocket  signal  find  an  ambulance  and  crew 
at  the  pier  or  beach  to  meet  them  and  transport 


THE  HEALTH  OF  THE  NAVY     351 

them  to  a  hospital  bed  within  thirty  or  forty  minutes 
at  the  outside. 

Then,  to  link  this  long  line  of  ambulances  and 
hospital  stations,  four  hospital  trains  were  con- 
structed, which  made  regular  backward  and  forward 
trips  on  an  average  every  three  days  from  the  north- 
ernmost group  of  hospitals  and  landing-stages  right 
down  to  the  great  Base  Naval  Hospitals  in  the  South, 
such  as  those  at  Chatham,  Portsmouth,  Plymouth, 
etc.  I  had  the  pleasure  of  making  the  trip  with  a 
company  of  sick  and  wounded  on  one  of  these  am- 
bulance trains  from  the  far  North  right  down  to 
the  southwestern  coast  of  England.  The  train  was 
made  up  of  twelve  coaches  and  had  cots  for  a  hun- 
dred and  twenty  and  sitting  space  for  fifty  lightly 
wounded.  They  had  a  staff  of  two  surgeons,  thirty- 
six  stewards  and  sick  berth  attendants,  and  were 
arranged  corridor  fashion,  so  that  the  surgeons  and 
attendants  could  readily  pass  from  one  end  of  the 
train  to  another  at  any  moment.  They  had,  of  course, 
a  kitchen  and  full  cook  staff  and  served  excellent 
meals  en  route,  and  had  a  well-equipped  dressing- 
room,  dispensary,  and  even  a  small  operating-room, 
where  emergency  cases  could  be  dealt  with.  Stops 
were  made  at  each  of  the  principal  towns,  where  sick 
or  wounded  who  had  recovered  sufficiently  to  travel 
and  wanted  to  go  south  were  taken  on,  or  where 
wounded  men  from  the  northern  bases  were  dis- 


352  THE  DOCTOR  IN  WAR 

charged  because  their  families  lived  in  that  neighbor- 
hood, and  so  would  be  able  to  visit  them  during  their 
convalescence  in  the  local  hospital.  It  would  have 
been  hard  to  imagine  anything  more  efficient  and 
more  comfortable,  and  it  left  in  one's  mind  a  feeling 
of  absolute  certainty  that  the  surgeons  of  the  British 
Navy  would  be  able  to  deal  promptly  and  effectively 
with  even  the  largest  possible  rush  of  wounded  from 
the  greatest  of  naval  engagements  in  record  time  and 
magnificent  style. 

As  for  the  general  health  of  the  Navy,  both  the 
British  and  our  own  can  show  the  same  splendid 
record  that  our  armies  can,  namely,  an  actual  reduc- 
tion of  its  already  low  level  in  time  of  peace,  and  far 
below  that  of  the  civilian  population  of  the  same  ages 
on  shore.  The  only  diseases  which  have  caused  any 
trouble  in  this  war  have  been  measles,  diphtheria, 
and  cerebro-spinal  meningitis  among  the  recruits  and 
boys  from  the  Naval  Reserve  chiefly  in  the  training 
schools  on  shore,  just  as  occurred  with  the  Army  re- 
cruits in  their  training-camps.  The  same  curious  in- 
creased susceptibility  to  the  milder  diseases  of  child- 
hood, such  as  measles  and  scarlet  fever,  as  was  shown 
in  the  Army  by  the  Australians,  the  New  Zealanders, 
and  the  recruits  from  Shetland  and  the  Orkney 
Islands,  has  also  shown  itself  in  the  Navy  among  the 
boys  from  the  same  Northern  islands.  Some  of  the 
surgeons  were  sufficiently  interested  to  trace  back  the 


THE  HEALTH  OF  THE  NAVY     353 

cases  and  communicate  with  the  local  physicians  in 
the  Northern  islands,  and  found  that  in  most  of  them 
measles,  for  instance,  would  only  occur  once  in  six  or 
seven  years,  when  infection  happened  to  be  brought 
in  by  children  from  the  mainland.  So  that  many  of 
the  Shetland  and  Orkney  boys  and  girls  grew  up  with- 
out ever  having  been  exposed  to  the  infection,  and 
the  community  as  a  whole  had  developed  no  distinct 
resistance  to  the  disease. 

There  has  also  been  some  slight  increase  in  the 
other  common  infections,  due  to  the  fact  that  a  flood 
of  new  recruits  has  poured  into  the  Navy  raising  its 
war  strength  to  nearly  three  times  the  numbers  of 
its  peace  footing.  But  the  new  recruits  have  for  the 
most  part  been  vigorous,  sturdy  men  and  boys,  a 
large  number  of  them  fishermen  or  coastwise  sailors 
and  merchantmen,  who  were  brought  into  the  mine- 
sweeping  and  patrolling  divisions,  and  the  excellent 
food  and  care  which  they  have  received  has  quickly 
brought  them  up  into  first-class  condition,  as  soon 
as  they  have  "sweated  out"  the  few  scattering  infec- 
tions which  they  brought  with  them  from  shore,  so 
that  the  total  sickness-rate  of  the  whole  force  has 
not  been  appreciably  increased. 

Rather  unexpectedly,  in  view  of  the  striking  purity 
and  healthfulness  of  sea  air  and  the  fact  that  sea 
voyages  have  long  been  recommended  for  the  cure  of 
pulmonary  disease,  there  has  been  a  slightly  larger 


354  THE  DOCTOR  IN  WAR 

number  of  invalldings  for  tuberculosis  than  might 
have  been  desired.  But  this  is  barely  half  the  rate  of 
this  disease  among  men  of  the  same  ages  on  shore, 
and  is  due  to  the  inevitable  and  perplexing  problem 
of  providing  adequate  ventilation  and  sufficiently 
frequent  change  of  air  for  a  thousand  men,  where 
there  is  theoretical  or  ideal  cubic  space  for  only  three 
hundred.  And  with  the  infinite  pains  and  skill  taken 
in  equipping  the  newer  ships  with  elaborate  systems 
of  forced  ventilation  by  means  of  fans,  even  this  age- 
old  problem  is  well  on  the  way  toward  solution.  The 
introduction  of  oil-burning  engines  and  of  turbines  is 
also  helping  to  solve  the  problem,  because  this  makes 
nearly  two  thirds  of  the  space  taken  by  coal  bunkers 
and  engine-rooms  available  for  sleeping-quarters  and 
mess-rooms  and  reading-rooms  for  the  men. 

The  largest  number  of  cases  under  one  heading 
falls  naturally  to  the  credit  of  that  special  pest  of 
the  soldier  and  the  sailor,  venereal  disease.  But  this, 
so  far  from  increasing  during  the  war,  has  shown  a 
marked  and  gratifying  diminution,  due  to  the  new 
and  intelligent  methods  of  dealing  with  it.  In  fact 
it  was  the  Navy  that  was  the  first  to  set  the  example, 
which  has  been  followed  by  the  Army  with  admirable 
results.  Frank  and  friendly  talks  were  given  to  the 
seamen  by  the  Fleet  surgeons,  covering  every  aspect 
of  the  subject,  the  dangerous  after-effects  of  the 
disease  and  its  menace  to  their  future  wives  and 


THE  HEALTH  OF  THE  NAVY     355 

children.  Then  they  were  given  protective  remedies 
against  it,  and  were  told  that  if,  on  their  return  to 
the  ship,  they  promptly  reported  to  the  hospital 
orderlies  if  they  had  been  exposed  to  infection,  they 
would  be  put  under  treatment  at  once  and  neither 
punished  nor  docked  of  their  pay  even  if  the  infection 
should  develop. 

Theoretically,  this  method  is  open  to  the  single 
objection  that  it  teaches  the  men  how  they  may  run 
risks  with  comparative  impunity.  But,  practically, 
this  possible  lessening  of  the  fear  of  infection  has  been 
heavily  overbalanced  by  the  increase  of  the  men's 
intelligence  and  knowledge  of  the  disease  and  the 
appeal  to  their  patriotism  and  their  respect  for  their 
wives  and  future  children.  In  the  paradoxical  lan- 
guage of  a  famous  cynic,  "Nothing  survives  being 
thought  of,"  not  even  the  running  of  venereal  risks. 
At  all  events,  the  figures  have  fallen  to  barely  half 
of  the  peace-time  prevalence  of  the  diseases,  that  is 
to  say,  about  five  in  a  thousand.  What  this  means 
may  be  gathered  from  the  instance  of  one  large  battle- 
ship, which  on  touching  at  a  certain  port  gave  eleven 
hundred  of  its  men  shore  leave,  with  the  result  that 
only  three  cases  of  venereal  disease  followed ! 

By  a  curious  paradox  the  next  prominent  disease  in 
the  Navy  in  time  of  war  is  neurasthenia  and  mental 
depression.  What  a  set  of  bluff  and  jolly  "Jack 
Tars,"  in  their  home  on  the  ocean  wave  in  piping 


356  THE  DOCTOR  IN  WAR 

times  of  war,  should  be  doing  with  a  parlor  disease 
like  this  is  at  first  sight  a  puzzle.  But  it  is  explained 
by  the  fact  that  after  the  first  few  months,  when 
there  were  still  a  few  German  war  vessels  and  cruisers 
afloat  to  provide  a  moderate  amount  of  excitement, 
the  task  of  the  Navy  has  been  one  of  constant 
and  sleepless  strain  and  watchfulness  in  all  sorts  of 
weathers  —  except  good  —  with  the  most  tremen- 
dous interests  and  responsibilities  hanging  upon  any 
slackening  of  vigilance,  and  with  nothing  whatever 
happening  to  break  the  monotony.  They  have 
cruised  backward  and  forward,  backward  and  for- 
ward, in  fog  and  rain  and  spindrift,  and  snow  and 
storm  and  sleet,  day  after  day,  month  after  month, 
for  four  mortal  years,  and  except  for  the  Battle  of 
Jutland,  the  clash  off  Heligoland,  and  an  occasional 
brush  between  destroyer  patrols,  with  nothing  what- 
ever to  show  for  it.  This  is  admirable  prudence  on 
the  part  of  the  enemy,  but  bitterly  disappointing  to 
our  sailor-boys.  To  sweep  the  sea  for  four  long  years 
with  the  finest  fleets  ever  assembled  under  one  group 
of  flags  and  be  unable  to  get  a  fight  out  of  anybody 
is  enough  to  drive  any  set  of  sailors  to  mental  depres- 
sion or  to  drink. 

Of  course,  they  know,  and  the  world  well  knows, 
that  they  have  swept  the  seas  of  the  world  clear  of 
every  craft  that  dares  fly  the  enemy's  flag  above  the 
surface,  that  they  have  drawn  a  noose  around  the 


THE  HEALTH  OF  THE  NAVY     357 

neck  of  the  German  Brute  and  are  slowly  but  surely 
strangling  him  to  death,  that  but  for  their  superb, 
devoted  and  almost  thankless  service  the  war  would 
have  been  ended  in  six  months,  that  they  have 
transported  and  convoyed  across  the  seas  millions  of 
troops,  their  equipment  and  four  years*  supplies,  with 
the  loss  of  less  than  a  thousand  soldiers,  and  have  kept 
all  the  highways  of  the  seas  the  world  over  safe  for 
the  commerce  of  civilization  and  freedom.  But  this  is 
poor  personal  consolation  to  half  a  million  fighting 
Jack  Tars,  all  of  them  just  praying  for  a  "scrap," 
and  it  is  little  wonder  that  they  get  melancholy  and 
despondent  in  their  minds  about  it.  The  only  nerve 
tonic  that  would  cure  their  depression  is  for  the  Ger- 
man polecat  to  come  out  of  his  hole  and  give  them  a 
chance  to  even  up  scores  and  express  their  opinion  of 
him  in  the  only  language  he  can  understand. 


XX 

SHELL-SHOCK  AND  THE  MENTAL  STRAIN 

OF  WAR 

THE  first  thing  that  was  predicted  of  this  war 
was  that  human  nerves,  especially  civilized 
nerves,  could  never  stand  the  strain.  That  our  sensi- 
tive neurasthenic  nervous  system,  keyed  up  and  pam- 
pered by  the  abnormal  conditions  of  city  life,  would 
break  down  under  the  shock  of  its  horrors.  Not  only 
would  our  soldiers  become  nervous  wrecks,  but  the 
ruin  of  their  mental  balance  would  be  so  utter  and 
foundation-shaking  that  generations  yet  unborn 
would  pay  the  penalty  in  an  inheritance  of  terror 
and  morbid  fear!  Forgetting,  as  any  biologist  could 
have  told  us,  that  the  nervous  system  is  by  a  strange 
paradox,  both  the  most  sensitive  and  the  toughest 
part  of  the  animal !  Here  the  war  has  been  going  full 
boiler-shop  hammer  and  tongs  for  three  years,  and 
our  insane  asylums,  instead  of  being  crammed  to 
overflowing  with  the  mental  wrecks  of  the  war,  are 
actually  getting  emptier  every  year,  and  the  thou- 
sands of  babies  bom  of  war  marriages  are  as  fat  and 
sturdy  and  crowing  and  normal  in  every  way  as  ever 
clutched  at  sunbeams  or  tried  to  get  their  pink  toes 
into  their  mouths. 


SHELL-SHOCK  359 

What  has  been  the  net  result  of  three  years  of  con- 
tinuous war  upon  the  nerves  of  the  soldiers?  Aston- 
ishingly little,  on  the  whole.  Indeed,  far  the  heaviest 
nerve-strain  of  this  war  has  fallen  upon  the  anxiously 
waiting  or  bitterly  weeping  wives  and  mothers  and 
sisters  at  home.  Yet  column  after  column  and  head- 
line upon  headline  have  been  devoted  to  ''shell- 
shock.'' 

As  soon  as  you  come  to  look  into  the  facts  of  the 
situation  you  find,  first,  that  the  term  "shell-shock" 
has  been  and  is  yet  extremely  loosely  used,  and  sec- 
ond, that  it  has  attracted  ten  times  the  attention 
that  its  importance  really  deserves. 

"Shell-shock,"  in  fact,  has  been  applied  as  a  con- 
venient term  for  any  form  of  disability  in  a  soldier  not 
accompanied  by  a  visible  wound,  or  other  clear  physi- 
cal injury.  It  has  been  a  diagnostic  dump  on  which 
have  been  shot  all  sorts  of  disturbances  which  had 
no  clear  and  obvious  cause,  and  has  proved  as  blessed 
a  convenience  for  pathologic  haziness  as  "neuras- 
thenia," "uric  acid,"  or  "general  debility."  It  satis- 
fies both  doctor  and  patient  and  means  nothing  in 
particular. 

As  soon  as  the  litter  is  emptied  out  of  the  shell- 
shock  waste-paper  basket  and  attempt  is  made  to 
sort  it,  most  of  it  falls  roughly  into  two  quite  distinct 
and  different  groups. 

One,  in  which  the  patient,  or  his  comrades,  give  a 


36o  THE  DOCTOR  IN  WAR 

clear  history  of  his  having  been  knocked  down,  or 
hurled  some  distance,  or  blown  up  into  the  air,  or  not 
infrequently  buried  by  the  blast  of  a  high-explosive 
shell.  He  is  picked  up  unconscious  and  awakens  in  a 
dazed,  half-delirious  state.  Or  else  he  is  found  wan- 
dering about  in  a  sort  of  walking  delirium,  quite  out 
of  his  head,  having  forgotten,  not  only  what  caused 
his  condition,  but  also  the  number  of  his  regiment,  its 
bivouac,  and  even  his  name. 

After  a  few  days'  rest  and  care,  his  delirium  sub- 
sides, his  memory  comes  back,  he  complains  of  in- 
tense fatigue,  weakness,  and  general  muscular  sore- 
ness, due  probably  to  the  physical  shock  and  violence 
inflicted  by  explosion;  but  this  steadily  improves, 
and  unless  internal  damage  has  been  done  most  of 
this  class  of  cases  get  well. 

A  few,  however,  unfortunately,  remain  perma- 
nently weakened  both  physically  and  mentally,  al- 
though their  minds  clear  and  memory  comes  back, 
and  still  fewer  break  down  rapidly  and  ultimately  die. 
Post-mortems  held  upon  some  of  these  show  innum- 
erable small  hemorrhages  scattered  all  through  the 
substance  of  the  brain,  due  to  the  rupture  of  tiny 
blood-vessels  by  the  terrific  shock,  even  though  the 
skull  itself  was  not  fractured.  This  greatly  helps  to 
explain  the  symptoms  of  this  class  of  cases,  for  prob- 
ably many  who  remain  permanently  weakened  both 
muscularly  and  nervously  have  had  their  brain  sub- 


SHELL-SHOCK  361 

stance  actually  damaged  in  this  way,  though  not 
severely  enough  to  cause  either  paralysis  or  death. 

Shell-shocks  of  the  second  group,  though  at  first 
sight  somewhat  similar,  are  really  quite  different  in 
character.  They  resemble  those  of  the  first  group  in 
that  they  usually  occur  after  a  battle  and  the  patient 
is  found  wandering  about  in  a  dazed  or  demented 
condition. 

But  here  the  likeness  ends,  for  when  the  victim 
rambles  or  is  brought  into  a  Field  Hospital,  he  often 
gives  a  most  dramatic  and  harrowing  story  of  having 
been  hurled  yards  up  into  the  air  by  a  tremendous 
explosion,  or  buried  for  hours  in  a  dug-out  or  shell- 
crater,  or  seeing  his  comrades  blown  to  pieces  before 
his  eyes,  and  perhaps  spattered  with  their  blood  and 
brains!  Quite  different  from  the  halting  speech  and 
hazy  memories  of  the  real  shell-shocks.  On  investiga- 
tion his  moving  story  is  usually  found  to  be  only 
partially  true,  and  often  totally  unfounded  —  a  pure 
hallucination  in  fact.  He  may  prove  not  to  have  been 
in  the  front  trenches  at  all,  or  to  have  come  from  a 
part  of  the  line  not  under  fire! 

Then  he  quickly  begins  to  develop  a  whole  crop  of 
curious  symptoms,  such  as  no  physical  injury  could 
possibly  produce.  He  becomes  suddenly  totally 
blind,  or  deaf,  or  dumb,  with  no  sign  of  actual  brain 
or  nerve  damage,  and  as  might  have  been  expected 
after  weeks  or  months  completely  recovers  his  sight, 


362  THE  DOCTOR  IN  WAR 

or  hearing,  or  speech,  as  suddenly  as  he  lost  it.  One 
or  both  of  his  hands  close  firmly  and  can  hardly  be 
pried  open,  or  his  legs  suddenly  draw  up  in  bed  and 
he  can't  possibly  straighten  them. 

Commonest  of  all  is  a  curious  twitching  of  certain 
groups  or  of  most  of  his  muscles,  so  that  he  cannot 
hold  his  head  still,  or  walk  or  stand,  except  with  inces- 
sant jerkings  and  tremblings,  and  if  he  attempts  to 
speak  he  stutters  and  stammers  in  the  most  appalling 
way.  All  these  jerkings  and  twitchings  are  increased 
by  excitement.  You  are  brought  into  a  shell-shock 
ward  and  stop  to  look  at  one  of  the  patients.  In- 
stantly he  begins  to  stammer  and  jerk,  then  the  man 
across  the  aisle  follows  suit,  and  the  contagion  spreads 
in  widening  circles  until  the  whole  ward  is  set  jerking 
and  twitching.  All  the  movements  and  most  of  the 
spasmodic  contractions  cease  during  sleep. 

In  fine  there  is  a  strong  element  of  what  for  want 
of  a  better  word  we  term  *' hysteria ''  in  this  class  of 
symptoms.  But  let  it  be  clearly  understood  that 
whatever  hysteria  may  be  found  to  mean,  it  does  not 
mean  shamming  or  deliberate  pretense!  The  poor 
fellows  are  far  too  miserable  and  really  ill  for  that. 

In  fact,  this  second  class  of  shell-shocks  clearly 
represent  men  of  defective  nervous  systems  or  ill- 
balanced  minds  who  have  been  thrown  off  their  bal- 
ance by  the  strains  and  stresses  of  war.  Some  of 
them  might  have  been  able  to  "carry  on''  and  ''get 


SHELL-SHOCK  363 

by"  indefinitely  in  the  milder  times  of  peace,  but  the 
conviction  is  steadily  deepening  among  mental  ex- 
perts that  the  breakdown  of  most  of  them  has  only 
been  hastened  by  the  shock  of  war.  In  other  words, 
they  represent  little  more  than  the  normal  average 
insanity  rate  among  men  of  military  ages. 

One  of  the  most  striking  features  of  this  war  has 
been  the  tremendous  and  incessant  character  of  the 
roar  and  thunder  of  battle.  The  world  has  stood 
aghast  at  the  astounding  development  of  ordnance, 
the  unexpected  and  well-nigh  incredible  increase  in 
the  size,  range,  and  number  of  heavy  guns,  the 
undreamed-of  expenditure  of  ammunition,  and  the 
way  in  which  the  war  has  become  one  of  heavy  artil- 
lery, the  infantry  in  many  cases  only  going  forward 
to  pick  up  the  pieces  after  the  big  guns  have  done 
their  work.  Indeed,  preparing  the  ground  for  infan- 
try is  technically  known  as  *' cultivating  the  soil." 

An  army  which  for  nearly  twenty  years  was  consid- 
ered well  equipped  for  battle  with  a  few  score  heavy 
cannon  now  calls  for  thousands.  More  ammunition 
is  expended  in  two  days'  offensive  on  the  Somme 
than  was  spent  in  the  whole  of  the  Boer  War.  Add 
to  this  that  the  range  of  the  average  heavy  gun  is 
now  about  seven  miles,  and  that  the  really  big  ones 
can  carry  up  to  sixteen  and  eighteen,  so  that  the 
soldier  never  knows  when  he  is  safe;  that  all  projec- 


364  THE  DOCTOR  IN  WAR 

tiles  are  explosive,  many  of  them  being  as  tall  as  a 
man  and  weighing  fifteen  hundred  pounds,  and  that 
the  crash  which  they  make  when  they  land  is  like  the 
blowing-up  of  a  mine  or  the  explosion  of  a  powder 
factory  —  and  you  can  form  some  faint  picture  of 
the  nerve-racking  bellow  and  thunder  and  roar  of 
shell-burst  in  which  the  modern  soldier  has  to  live 
and  fight.  The  marvel  at  first  sight  (and  hearing)  is 
that  even  the  most  iron  nerves  should  be  able  to  stand 
the  strain  or  the  best-balanced  reason  escape  ship- 
wreck, or  at  least  grave  disturbance. 

Another  factor  in  "frazzling"  a  susceptible  nervous 
system,  which  is  not  perhaps  quite  fully  appreciated, 
is  the  tension  produced  by  the  incessant  strain  of  day 
and  night  watchfulness  against  shell-fire.  In  former 
wars  a  soldier  in  the  open  field  *'went  under  fire" 
for  a  few  tense,  thrilling  hours  of  battle,  and  then  he 
either  drove  back  the  enemy  or  withdrew  out  of  the 
range  of  his  guns.  Now  he  is  literally  under  fire  every 
minute  of  the  time,  from  the  moment  that  he  detrains 
at  the  rail-head  to  the  day  that  he  is  lifted  into  the 
Hospital  train  for  Blighty  or  his  regiment  is  with- 
drawn for  reinforcements  and  repairs. 

Offensives  come  and  go  at  intervals  it  may  be  of 
months,  night  raids  into  the  enemy's  trenches  occur 
weekly,  perhaps,  in  limited  areas,  but  the  duel  of 
the  artillery  never  ceases.  From  the  time  you  arrive 
within  twenty  miles  of  the  trenches  you  can  hear  it 


SHELL-SHOCK  365 

booming  and   thudding  and  thundering,   day  and 
night,  like  the  roar  of  a  heavy  surf  on  a  rocky  coast. 

Moreover,  on  account  of  the  tremendous  reach  of 
modern  artillery,  most  of  the  reserve,  or  rest  camps, 
both  in  huts  and  in  villages,  to  which  the  troops  are 
brought  back  between  turns  of  trench  duty,  are  within 
possible  range  of  the  enemy's  guns,  and  he  takes  excel- 
lent care  to  remind  them  of  that  fact  at  frequent 
intervals.  Hence,  in  quiet  parts  of  the  line,  between 
active  offensives,  it  not  infrequently  happens  that 
more  men  are  actually  killed  by  shell-fire,  *'in  their 
beds,"  so  to  speak,  in  the  reserve  camps,  than  are 
hit  in  the  first-line  trenches. 

In  addition  to  this,  the  Germans  always  have  a 
few  extra  heavy  naval  or  other  long-range  guns  with 
which  they  keep  constantly  "reaching  out"  ten, 
twelve,  and  even  fifteen  miles  for  everything  their 
airmen  can  see  which  shelters,  or  looks  as  if  it  might 
shelter,  any  living  human  creature,  whether  they  be 
camps  or  villages,  forts  or  churches,  hospitals  or  rail- 
heads. The  motto  of  the  Hun  at  war  is,  "  Kill  every- 
thing you  can  reach,  it  may  help  the  cause  somehow  " ; 
and  he  makes  war,  not  against  an  army,  but  a  whole 
nation. 

On  the  other  hand,  there  are  certain  redeeming, 
features  of  this  incessant  turmoil  and  uproar  which 
lessen  its  racking  effect  upon  the  nerves.  The  soldier 
is  never,  so  to  speak,  at  both  ends  of  the  flight  of  a 


366  THE  DOCTOR  IN  WAR 

shell.  From  the  very  fact  of  the  tremendous  range 
of  the  guns,  if  he  is  in  the  front-line  trenches,  for  in- 
stance, he  practically  does  not  hear  the  enemy*s  guns 
which  are  firing  at  him,  at  all,  or  only  as  a  confused, 
distant  roar  and  rumble. 

On  the  other  hand,  his  own  artillery  is  some  miles 
behind  him,  so  that  all  he  hears  of  his  own  guns  is  a 
moderate  boom  and  roar,  with  the  clear  whistle  of 
their  shells  over  his  head,  which  on  the  whole  is  con- 
soling, rather  than  otherwise,  and  helps  to  steady  his 
nerves  by  assuring  him  that  he  is  being  well  supported 
and  protected.  So  all  that  his  ear-drums  have  to 
stand  is  the  explosion  of  the  enemy*s  shells  as  they 
arrive,  and  these,  though  bad  enough,  do  not  make 
half  the  fierce  concussion  and  nerve-racking  noise  of 
the  firing  of  the  guns  themselves.  Besides,  so  many 
of  the  shells  pass  over  his  head  or  fall  short,  or  land 
some  distance  up  or  down  the  line  from  him,  that  the 
constancy  of  their  arrival  in  close  or  dangerous  prox- 
imity is  not  nearly  so  great  as  it  might  be  supposed 
from  the  enormous  number  incessantly  hurled  in  his 
direction. 

Just  as  a  matter  of  nerve-straining  and  head-split- 
ting noise,  and  an  intolerable  row  and  racket,  the 
''hottest'*  place  a  soldier  can  get  into,  is  in  reserve, 
just  in  front  of,  or  just  behind,  his  own  guns.  I  have 
been  caught  there  several  times  myself,  and  can  speak 
feelingly.    It  seems  as  if  the  very  breath  were  going 


SHELL-SHOCK  367 

to  be  blown  out  of  your  body  and  your  head  split  or 
your  hair  torn  off  by  the  vicious  blast  and  whizz  of 
the  shells,  just  two  inches  above  the  top  of  your  cap, 
and  you  think  the  end  of  the  world  is  about  to  come. 
But  after  twenty  or  thirty  minutes  of  gasping  and 
reeling,  you  gradually  adjust  yourself,  realize  that  it 
is  not  going  to  kill  you  after  all,  or  even  do  you  any 
serious  damage,  and,  by  and  by,  you  derive  a  little 
mild  consolation  from  the  thought  of  what  this  tre- 
mendous roaring  and  belching  must  be  doing  to  the 
enemy  at  the  other  end  of  the  range. 

In  fact,  it  is  quite  within  the  powers  of  the  human 
nervous  system  to  call  up  its  reserves  and  adjust  itself 
even  to  the  murderous  and  appalling  crash  and  thun- 
der and  shriek  of  modern  artillery  bombardment. 
Gradually  it  dawns  upon  the  young  recruit  that  not 
one  thousandth  part  of  the  horrid  and  astounding 
racket  and  roar  and  crash  that  he  hears  means  any- 
thing to  him  personally,  not  one  in  fifty  of  the  shells 
that  he  sees  or  even  hears  explode  puts  his  individual 
life  in  any  danger. 

He  learns  to  distinguish  instantly  and  almost  un- 
consciously without  even  thinking  about  it,  between 
the  clear,  cheery,  diminishing  whistle  of  his  own 
departing  shell,  and  the  hoarse,  menacing,  crescendo, 
raucous  scream  of  the  arriving  enemy  shell.  Indeed, 
incredible  as  it  may  seem,  the  big  noise  soon  comes 
to  mean  little  or  nothing  to  him  at  all,  as  no  gun  that 


368  THE  DOCTOR  IN  WAR 

he  can  hear  is  going  to  touch  him  and  every  shell  that 
he  hears  explode  has  missed  him ;  for  if  it  landed  close 
enough  to  strike  him  the  fragments  would  arrive 
before  the  sound  did.  The  Sinai tical  thunder  and 
mighty  roaring  wind  of  the  big  guns  and  the  bursting 
shells  leave  him  unmoved.  The  only  thing  that  tries 
his  soul  and  vexes  his  nerve  is  the  still,  small  voice  of 
the  angry  whine  of  the  approaching  shell,  rising 
swiftly  shriller,  more  threatening,  and  more  personal 
every  instant,  till  it  suddenly  changes  to  a  delightful 
and  soul-relieving  diminuendo  over  your  head  and  be- 
yond, or  ends  in  a  dull  thud  and  roar  "out  of  bounds," 
or  "  off  the  map,"  so  far  as  you  are  concerned.  For  the 
moment  you  have  the  most  utter,  disgracefully  im- 
moral and  anti-social  indifference  as  to  whom  or  what 
it  may  have  landed  on  or  hit,  so  long  as  it  has  missed 
you.  Even  selfishness  has  its  uses  and  fatalism  is  a 
positive  life-saver  when  applied  to  nerve-strain  from 
war  dangers. 

As  the  charm  of  newness  and  the  glamour  of  dra- 
matic appeal  are  falling  away  from  shell-shock,  much 
of  its  mystery  is  clearing  up.  It  is  coming  to  be  recog- 
nized as  chiefly  the  revelation  of  the  measure  of 
nervous  unfitness  and  mental  unbalance  admitted 
into  our  Army.  In  other  words,  the  number  of  men 
enlisted  who  never  ought  to  have  been  accepted  at  all ! 

This,  of  course,  does  not  apply  to  what  might  be 


SHELL-SHOCK  369 

described  as  the  *'bIown-up-and-knocked-down'' 
group,  who  are  perfectly  normal  men,  temporarily 
dazed  and  disabled  by  a  terrific  blow  on  the  head. 
These  usually  recover  fairly  promptly,  except  an  un- 
fortunate minority  who  have  suffered  actual  brain 
hemorrhages  or  other  internal  injuries. 

But  the  great  body  of  lasting  or  permanent  shell- 
shocks,  who  linger  on  for  months  and  even  years  to 
try  the  souls  and  defy  the  healing  skill  of  both  Army 
doctors  and  specialists  at  Base  Hospitals,  and  who 
fill  three  fourths  of  the  beds  in  the  wards  and  hospi- 
tals specially  set  apart  for  shell-shock,  are  of  a  totally 
different  type.  In  the  first  place,  most  of  them  are 
almost  as  defective  physically  as  they  are  mentally 
—  undersized,  under- weight,  narrow-chested,  shuffle- 
gaited,  slack-jawed,  with  badly  shaped  heads,  irregu- 
lar features,  and  vacant  or  restless  expressions.  Take 
fifty  or  more  of  them  together  and  the  impression  of 
what  the  mental  experts  term  **  constitutional  inferi- 
ority" is  unmistakable.  This  is  confirmed  by  hun- 
dreds of  actual  measurements,  height,  weight,  chest- 
girth,  muscular  power,  taken  in  the  larger  special 
hospitals  for  their  care. 

In  the  second  place,  careful  tracing  of  the  previous 
history,  both  of  the  patient  and  his  family,  carried 
out  in  over  two  thousand  cases  by  such  eminent 
authorities  as  Dr.  F.  W.  Mott,  of  the  Maudsley  Hos- 
pital, London,  show  clear  proof  of  previous  attacks  of 


370  THE  DOCTOR  IN  WAR 

mental  disturbance  and  nervous  instability  in  either 
the  shell-shock  himself  or  his  near  relatives  and  ances- 
tors in  two  thirds  of  all  cases. 

Furthermore,  these  lasting  cases  of  shell-shock 
show  a  marked  "up-and-down"  or  "circular"  char- 
acter, just  like  ordinary  insanity,  a  tendency  to 
periods  of  improvement,  even  reaching  apparent 
recovery,  quickly  followed  by  relapse,  usually  to  a 
little  lower  level  than  before.  Not  a  few  of  the  pa- 
tients at  the  Maudsley  Hospital  were  there  for  the 
second  and  even  the  third  time,  having  recovered 
and  been  sent  to  the  Front  in  between.  One  poor 
fellow,  who  was  pluckily  anxious  to  return,  lasted 
just  three  weeks  after  he  again  reached  the  trenches, 
and  another  only  three  days!  Which  makes  rather 
expensive  soldiers! 

In  fine,  a  large  share  of  shell-shock  is  merely 
ordinary  insanity  occurring  in  war-time  and  having 
its  delusions  colored  by  the  fears  of  the  battle-field 
and  given  a  military  stamp.  Several  common  forms 
of  insanity  begin  with  what  are  called  "delusions  of 
persecution."  The  patient  is  firmly  convinced,  ob- 
sessed in  fact  by  the  idea,  that  certain  persons  or 
agencies,  usually  unknown  and  referred  to  as  "they," 
or  "the  same  lot,"  are  "after  him,"  either  with  the 
intention  of  doing  him  bodily  injury  or  that  they  are 
spreading  all  sorts  of  malicious  lies  and  false  reports 
about  him  among  his  friends  or  his  fellows  or  with 
his  employers. 


SHELL-SHOCK  371 

If  he  happens  to  begin  to  break  down  in  the  camp 
or  at  the  Front,  these  impersonal,  unknown  enemies 
naturally  become  Germans  or  German  spies,  or  even 
individual  German  guns,  which  he  will  assure  you 
with  tears  in  his  eyes  are  specially  shooting  at  him, 
following  him  about  to  different  places,  and  have 
only  just  missed  him  several  times  and  next  time  will 
surely  "get  him." 

One  poor  boy  whom  I  saw  kept  coming  back  to 
camp  and  reporting  most  detailed  and  circumstan- 
tial hair-breadth  escapes  of  this  sort  from  enemy 
shells,  when  no  one  else  had  seen  or  heard  any  shells 
fall  in  his  particular  part  of  the  field.  His  surgeon, 
finding  him  a  nervous  wreck,  sent  him  back  to  the 
Base,  and  there  his  hallucinations  promptly  changed 
to  the  pitiful  idea  that  he  had  shown  the  white 
feather  and  that  ''voices*'  were  going  about  inform- 
ing everybody  of  that  fact,  so  that  people  stared  and 
pointed  at  him  on  the  street.  This  so  preyed  on  his 
mind  that  he  finally  made  a  desperate  attempt  to 
commit  suicide  and  broke  down  into  unmistakable 
insanity.  He  had  made  an  excellent  record  for  both 
bravery  and  devotion  to  duty  before  the  inborn  defect 
in  his  brain  began  to  manifest  itself.  I  say  inborn, 
because  later  inquiries  revealed  the  fact  that  his 
father  had  committed  suicide  while  insane. 

Another  English  soldier  who,  after  several  tempo- 
rary  attacks   of   shell-shock,   had  at   last  become 


372  THE  DOCTOR  IN  WAR 

clearly  demented,  was  being  sent  away  to  an  asylum 
from  one  of  the  war-hospitals  I  was  visiting.  The 
specialist  in  charge  was  looking  him  over  for  the  last 
time  and  signing  up  his  papers,  and,  as  required  by 
law,  asked  him  the  question,  "Have  you  any  com- 
plaints to  make  of  your  treatment  here?'*  *'No," 
said  the  patient;  ''no,  but  I  do  wish  you  had  taken 
this  wireless  receiving  station  out  of  my  stomach.  The 
Huns  keep  sending  me  the  nastiest,  most  disagreeable, 
and  insulting  messages  through  it  and  I  can't  stop 
'em!"  "Well,"  said  the  doctor  with  a  smile  at  me, 
"why  don't  you  get  a  pair  of  clippers  and  cut  the 
wires?"  "Ah,  I  can't  do  that  you  know,  it's  wire- 
less!'^ Even  the  hallucinations  of  the  insane  have  to 
be  strictly  scientific  and  up  to  date  nowadays. 

Another  young  soldier,  scarcely  more  than  a  boy, 
whom  I  saw  in  one  of  the  Base  Hospitals  in  France 
for  shell-shock,  had  settled  upon  bombs  as  his  par- 
ticular enemy  and  hete  noir.  He  had  walked  into  the 
Field  Hospital  after  a  battle,  in  a  sort  of  somnambu- 
listic state,  and  immediately  upon  being  put  to  bed 
fell  into  a  deep  sleep  from  which  it  seemed  impossible 
to  awake  him.  If  liquids  were  placed  in  his  mouth 
he  would  swallow  them;  so  he  was  fed  through  a 
spouted  cup  for  several  days,  when  it  was  found  that, 
although  he  would  pay  no  attention  to  the  loudest  of 
shouting  or  vigorous  shakings,  if  food  was  placed 
close  to  his  nose  so  that  he  could  smell  it,  he  would 


SHELL-SHOCK  373 

reach  out  for  the  plate  and  proceed  to  feed  himself 
with  his  fingers,  still  keeping  his  eyes  firmly  closed. 

All  sorts  of  means  short  of  unjustifiable  violence 
were  adopted  to  try  and  bring  him  out  of  his  hys- 
terical sleep  or  self-hypnosis,  including  shouting  va- 
rious alarms  into  his  ear,  but  without  the  slightest 
effect  until  it  was  discovered  one  day  that  there  w£is 
just  one  word  to  which  he  would  react  and  fairly 
promptly,  and  that  word  was  "Bombs."  To  this 
word  he  would  respond  at  once  and  in  a  most  curious 
and  definite  manner.  The  doctor,  after  giving  us  his 
history,  but  without  telling  us  what  to  expect,  shook 
the  sleeper,  shouted  his  name  in  his  ear  loudly  and 
flashed  a  big  electric  torch  in  his  face  two  or  three 
times  without  the  slightest  response.  Then  he  called 
out,  in  much  lower  tones  than  he  had  used  before, 
"The  bombs,  where  are  the  bombs?"  at  the  same 
time  throwing  an  old  briar-wood  pipe  under  the 
bed. 

Instantly  the  sleeper  stirred,  lifted  himself  slowly 
from  the  pillow,  rolled  out  of  bed  onto  the  floor, 
and  dived  under  his  cot.  There  he  groped  about,  still 
with  his  eyes  firmly  shut,  until  he  found  the  pipe, 
threw  it  out  of  the  window,  and  crawled  back  into 
bed  again.  I  say  "out  of  the  window,"  but  in  reality 
it  struck  against  a  screen  with  which  the  window  had 
been  covered,  because  at  the  first  trial,  before  it  was 
known  what  he  would  do  with  the  "bomb,"  he  had 


374  THE  DOCTOR  IN  WAR 

been  allowed  to  pick  up  a  good-sized  electric  torch 
and  hurl  it  through  the  glass. 

Evidently  he  had  become  vividly  in  dread  of  the 
possibility  of  bombs  being  thrown  into  the  bay  of 
the  trench  which  he  occupied,  but  he  had  n't  even  a 
bruise  or  a  scratch  on  him  anywhere,  and  no  history 
could  be  obtained  of  his  having  had  any  particularly 
narrow  or  hair-breadth  escapes  from  the  explosion 
of  a  bomb  or  seeing  any  of  his  comrades  blown  to 
pieces  by  one. 

Now  come  the  important  practical  questions,  What 
is  to  be  done  for  shell-shock?  and,  What  is  the  pros- 
pect for  recovery?  Obviously  neither  of  these  ques- 
tions can  be  answered  in  a  sentence,  for  there  are 
almost  as  many  different  kinds  of  shell-shock  as  there 
are  of  shocked  soldiers ;  while  as  for  treatment,  some 
will  recover  without  anything  but  a  judicious  "let- 
ting alone,"  others  will  get  steadily  worse  in  spite  of 
every  known  and  imaginable  treatment.  However, 
certain  broad  general  lines  can  perhaps  safely  be  laid 
down,  always  vividly  remembering  that  few  diseases 
follow  rigid  rules,  and  that  shell-shock  seems  to  con- 
sist chiefly  of  exceptions. 

In  the  first  place,  while  recovery  is  always  slow, 
the  prospects  for  regaining  a  moderate  amount  of 
comfort  and  efficiency  are  fairly  good  in  the  great 
majority  of  cases.  Naturally,  there  is  a  wide  differ- 
ence between  the  two  different  classes  of  shell-shock 


SHELL-SHOCK  375 

patients.  Those  of  the  first  class,  normal,  vigorous 
men  who  have  suffered  definite  physical  violence 
from  explosion  or  burying,  although  it  may  not  have 
actually  broken  a  bone  or  visibly  marked  the  surface 
of  their  bodies,  have  in  the  nature  of  the  case  much 
the  best  chance  of  recovery.  In  fact,  it  may  confi- 
dently be  expected  that  two  thirds  to  three  fourths 
of  them  will  get  well,  all,  in  fact,  except  those  who 
have  suffered  hemorrhages  or  other  internal  injuries 
to  the  brain  or  spinal  cord. 

It  must,  however,  be  remembered  that  there  are  a 
good  many  border-line  cases  in  which  the  shell-burst 
that  actually  knocked  them  down  or  stunned  them 
was  only  the  last  finishing  touch  of  a  series  of  war- 
strains  both  physical  and  mental,  which  had  been  for 
some  time  breaking  down  their  nervous  resistance. 
These,  of  course,  will  recover  very  slowly,  and  will 
often  have  great  difficulty  in  reaching  a  sufficiently 
complete  recovery  of  balance  to  allow  them  to  return 
to  their  posts  and  to  continue  to  stand  up  under 
the  same  strains  which  broke  them  down  before. 
In  fact,  it  may  be  frankly  said,  that  as  a  general  rule 
it  does  not  pay  to  send  recovered  shell-shocks  back 
to  the  Front.  Especially  as  there  are  plenty  of  posi- 
tions behind  the  lines,  where  they  can  be  of  even 
more  military  value. 

Even  in  the  second  class  of  shell-shocks,  those 
unfortunates  in  whom  the  war  and  its  dangers  and 


376  THE  DOCTOR  IN  WAR 

strains  only  slightly  hastened  the  time  of  their  break- 
down and  determined  the  character  of  their  delu- 
sions, the  prospects  for  recovery  are  fairly  favorable 
in  the  majority  of  cases,  though  this  recovery  natu- 
rally will  seldom  be  complete  and  may  not  be  perma- 
nent. There  is  an  exaggerated  feeling  of  dread  and 
aversion  to  the  term  ''insanity,'*  which  has  seriously 
hindered  the  proper  acknowledgment  and  treatment 
of  these  cases,  because  it  is  believed  that  the  mere 
use  of  the  term  is  equivalent  to  sentence  of  lifelong 
incarceration  in  an  asylum. 

So  far  from  this  being  the  case,  fully  one  third  to 
one  half  of  all  cases  of  insanity,  even  of  so  advanced 
and  clear  a  type  as  to  be  admitted  to  an  asylum  in 
times  of  peace,  recover  in  the  sense  of  being  able 
again  to  maintain  and  take  care  of  themselves  in  the 
battle  of  life.  And  in  the  case  of  these  breakdowns  in 
the  soldiers,  we  have  the  great  additional  advantage 
of  being  able  to  give  them  a  complete  and  striking 
relief  from  the  strains  which  have  proved  too  much 
for  their  balance,  and  a  most  radical  and  restful 
change  of  scene  merely  by  withdrawing  them  from 
the  Front  and  sending  them  well  back  to  the  Base, 
or,  still  more,  to  England.  There  careful  psychic  re- 
educational  treatment  with  baths,  massage,  tonics, 
etc.,  will  often  make  them  most  useful  soldiers  again, 
though  seldom  for  front-line  duty. 

While  a  good  many  of  this  class  of  shell-shock  cases 


SHELL-SHOCK  377 

were  probably  already  on  the  down  grade  mentally, 
and  it  was  only  a  question  of  time  when  the  final 
collapse  would  come,  not  a  few  of  these  war-wrecks 
would  probably  have  stood  the  wear  and  tear  of  busi- 
ness and  civil  life  for  a  considerably  longer  period, 
or  perhaps  indefinitely.  And  this  class  stand  a  good 
chance  of  recovery  by  being  sent  back  to  civilian  life. 

On  the  other  hand,  it  might  be  said  in  passing  that 
there  is  ground  for  the  paradoxic  belief,  that  while 
war-strains  break  down  a  certain  number  of  un- 
sound nervous  systems  earlier  than  normal,  they 
appear  to  stimulate  and  build  up  and  postpone  the 
breakdown  of  other  cases  with  poor  nervous  stability. 

The  one  consoling  fact  of  all  this  business  of  shell- 
shock  and  war-strain  is,  that  when  all  is  said  and 
done  and  its  seriousness  and  unmanageableness  fully 
recognized  and  every  known  case  listed  and  counted, 
the  sum  total  of  all  classes  which  last  more  than  two 
months  is  little  more  than  the  average  "normal "  per- 
centage of  insanity  among  men  of  military  age  in 
times  of  peace:  that  is  to  say,  about  two  per  thou- 
sand of  the  total  forces  on  the  Western  Front. 

A  similar  process  seems  to  be  taking  place  among 
the  civilian  population  at  home,  for  while  in  the 
beginning  of  the  war  there  was  a  slight  temporary 
increase  in  the  number  of  admittances  in  the  hospi- 
tals for  the  insane  in  England,  this  was  completely 
balanced  by  the  end  of  the  first  year,  and  for  the  past 


378  THE  DOCTOR  IN  WAR 

two  years  there  has  actually  been  a  falling-off  of  over 
two  thousand  cases  per  annum  in  the  number  of 
commitments  to  asylums. 

In  the  autumn  of  1917,  for  instance,  I  found  that 
the  total  number  of  all  cases  of  shell-shock  in  the 
military  hospitals  in  England  was  2760.  And  this 
represented  the  accumulations  of  three  years  of  war 
—  less  those  passed  on  to  insane-asylums  —  from 
an  army  of  at  least  five  million  men. 

Shell-shock  is  one  of  the  rarer  and  least  important 
of  the  wrecks  of  war. 

A  similar  process  in  less  degree  took  place  in  France. 
What  apparently  happened  was,  that  the  first  terrific 
shock  and  upheaval  of  the  war  upset  promptly  all 
those  who  were  near  the  point  of  a  mental  break- 
down. But  later  the  new  interests  and  responsibili- 
ties, the  new  enthusiasm  of  patriotism  and  devotion 
to  the  common  welfare  created  by  the  war,  lifted  the 
nervously  depressed  out  of  themselves  and  enabled 
them  to  get  a  new  grip  upon  life  and  sanity.  This  was 
probably  also  felt  in  the  working  classes  because  of 
the  abundant  employment,  for  even  unskilled  indi- 
viduals of  all  grades  of  capacity  had  high  wages,  which 
both  gave  them  a  more  cheerful  outlook  on  life  and 
enabled  them  to  feed  themselves  and  house  them- 
selves much  better. 

In  other  words,  civilized  man  evidently  still  pos- 
sesses wide  powers  of  adjustment  and  has  succeeded 


SHELL-SHOCK  379 

in  meeting  and  accommodating  himself  to  even  the 
terrible  strains  and  griefs  and  hardships  of  this 
colossal  war  in  the  most  surprising  and  gratifying 
manner.  This  is  particularly  noticeable  among  the 
men  out  at  the  actual  Front.  From  Ypres  to  the 
Isonzo,  from  the  Somme  to  Verdun,  wherever  one 
strikes  it,  one  is  instantly  impressed  with  the  fact 
that  the  Front  is  far  and  away  the  most  cheerful 
region  to  be  found  anywhere  in  this  war.  Instead  of 
being  depressed  by  their  hardships  and  dangers,  the 
actual  fighting  men,  whether  Tommies,  Anzacs, 
Poilus,  Alpini,  Yanks,  or  Bersaglieri,  seem  to  be  exhil- 
arated by  them.  Life  may  be  short  and  uncertain, 
but  that  shall  not  make  it  unhappy  while  it  lasts. 


XXI 

THE  HEALTH  OF  THE  AVIATOR:  SAVING 
THE  BIRD-MAN  FROM  EXTINCTION 

FOR  all  its  hugeness  and  complexity  there  is  only 
one  really  new  thing  in  this  whole  world-war, 
and  that  is  air  fighting.  At  first  sight  poison-gas 
might  seem  to  be  another,  but,  as  a  matter  of  fact, 
it  is  as  old  as  it  is  vile,  and  traces  its  malodorous 
ancestry  back  to  the  Oriental  stink-pots  and  the 
Greek  fire,  to  say  nothing  of  the  cuttlefish,  the  bom- 
bardier beetle  or  stink-bug,  and  the  black-and-white 
midnight  ravisher  of  our  hen-roosts.  War  has  be- 
come, not  merely  terrestrial  and  aquatic,  but  celes- 
tial as  well.  For  the  aeroplane  has  carried  it  up  into 
the  heavens  above,  as  the  dug-out  and  the  mine  have 
carried  it  into  the  earth  beneath,  and  the  submarine 
into  the  waters  under  the  earth. 

Being  new,  the  airman  was  and  is  yet  a  good  deal 
of  a  puzzle  to  the  professional  military  mind.  There 
was  first  of  all  great  difficulty  in  correctly  placing  or 
classifying  him  as  to  the  arm  of  the  service  to  which 
he  belonged.  He  obviously  did  not  march  on  foot,  so 
he  was  n't  infantry;  he  did  not  ride  on  a  gun-carriage, 
therefore  he  could  n't  be  artillery.  But  he  did  mount 
a  steed  of  some  sort,  even  if  only  a  winged  one,  a 


z 

o 

b 
Z 

u 

h 

a 

z 

o 

z 


THE  HEALTH  OF  THE  AVIATOR    381 

Pegasus;  therefore  he  belonged  to  the  cavalry.  Con- 
sequently, through  all  the  earlier  years  of  the  war, 
the  aviator  clanked  about  with  spurs  on  his  heels, 
which  were  just  as  useful  to  him  as  the  proverbial 
second  tail  to  a  cat. 

The  airplane  service,  though  it  is  new  and  will 
probably  win  the  war  in  the  end,  has  made,  on 
the  whole,  the  slowest  and  the  most  unsatisfactory 
progress  of  any  arm  of  the  service.  Infantrymen  — 
splendid  ones,  but  of  the  same  old  brand  that  have 
been  used  in  every  war  since  the  invention  of  gun- 
powder —  have  been  turned  out  by  the  million ; 
cavalry,  by  the  hundreds  of  thousands,  of  the  type 
that  Attila  used,  and,  as  cavalry,  just  about  as  use- 
ful in  the  first  three  years  of  the  present  war  as  so 
many  perambulators;  cannon,  by  tens  of  thousands; 
while  airplanes,  which  are  the  most  hopeful  chance 
of  doing  something  new  and  decisive  in  the  war, 
have,  after  four  years  of  war,  been  turned  out  in 
only  hundreds  or  even  tens,  although  the  cost  of 
one  is  barely  that  of  the  useless  chargers  required 
for  half  a  troop  of  cavalry. 

One  of  the  few  disappointments  of  my  six  months' 
succession  of  visits,  covering  at  least  two  thirds  of 
the  Western  Fronts,  including  the  Italian,  was  that 
the  highest  number  of  airplanes  that  I  ever  saw  in 
the  air  at  any  one  time  was  sixteen,  and  the  largest 
squadrilla  of  planes,  in  regular  formation  and  moving 


382  THE  DOCTOR  IN  WAR 

as  one,  was  nine,  seven  Capronis  and  two  Nieuports 
sailing  majestically  over  the  Carso  into  the  sunset  to 
bomb  Trieste. 

On  the  other  hand,  I  saw  everywhere  thousands  of 
splendid  cavalry  horses  doing  the  grasshopper  act; 
that  is  to  say,  eating  their  heads  off,  and  absorbing 
the  services  of  nearly  a  third  of  their  supposed  riders, 
the  other  two  thirds,  after  having  been  mounted  and 
equipped  to  ride,  regardless  of  expense,  being  dis- 
mounted, and  used  in  the  trenches  as  infantry.  And 
when  the  Ministry  of  Food  was  created  in  England, 
and  the  people  were  urged  to  use  as  much  as  possible 
of  oats  and  barley  in  the  place  of  the  precious  wheat, 
it  was  discovered  that  there  practically  were  no  oats 
left,  because  they  had  all  been  bought  up  by  the  Army 
Commissariat  Department  for  the  use  of  the  cavalry 
horses  in  France,  and  what  few  were  left  were  more 
expensive  than  wheat.  And  there  was  shortage  of 
barley,  because  most  of  it  had  been  fed  to  the  cattle 
and  pigs  and  poultry  to  make  up  for  the  shortage  of 
oats  and  wheat  offal. 

But  then  no  respectable  war,  of  course,  could 
possibly  be  conducted  without  cavalry,  and  it  is 
almost  pathetic  to  see  the  eagerness  with  which  the 
generals,  the  moment  that  the  battle  gets  out  into 
the  open  for  a  few  days,  jam  a  few  troops  of  cav- 
alry into  the  melee  by  main  force  and  then  turn 
round  and  proudly  remark,  ''There,  we  told  you 


THE  HEALTH  OF  THE  AVIATOR    383 

they  would  come  in  useful  sometime  if  you  only 
waited.'' 

There  was  a  story  going  the  rounds  among  the 
Tommies  when  I  was  at  the  Front,  to  the  effect  that 
some  one  had  actually  had  the  temerity  one  day  to 
ask  a  howling  swell  of  a  cavalry  officer,  what  use  the 
cavalry  had  actually  been  in  this  wan  "My  dear 
boy,"  said  the  exquisite,  with  an  air  of  wearied  con- 
descension, ''it  has  been  simply  of  priceless  value  by 
giving  tone  and  class  to  what  would  otherwise  have 
been  a  mere  vulgar  brawl." 

But  the  airplane  has  forged  ahead  after  a  sort,  in 
spite  of  its  being  the  Cinderella  of  the  General  Staff, 
though  the  darling  of  the  general  public,  whose  mili- 
tary instincts  are  often  surprisingly  sound.  It  devel- 
oped certain  internal  difficulties  of  its  own,  chief 
among  which  was  its  astonishing  infant  mortality, 
equaling  that  of  the  vilest  city  slum ;  from  twenty- five 
to  fifty  per  cent  of  those  who  were  *'bom"  into  its 
realm  dying  within  the  first  year  of  flying  life.  The 
grimly  pathetic  epigram  attributed  to  Guynemer, 
the  ace  of  aces,  that  the  successful  'flyer  won  first 
the  Croix  de  Guerre,  then  the  cross  of  the  Legion  of 
Honor,  then  the  wooden  cross,  had  a  most  painful 
amount  of  truth  in  it.  The  life  of  an  aviator  was  vari- 
ously alleged  to  be  anywhere  from  three  days  to  three 
months  after  he  had  fairly  learned  to  fly.  And  what 
was  worse,  the  mortality  in  training  was  said  to  be 


384  THE  DOCTOR  IN  WAR 

almost  as  great  as  that  in  actual  fighting  and  scout- 
ing. It  really  looked  as  though  the  war  plane  had 
settled  the  much-debated  scientific  problem  as  to 
why  the  flying  lizards  and  dragons  and  other  winged 
monsters  of  antiquity  had  become  extinct. 

For  a  long  time  this  was  regarded  solely  as  a  matter 
of  the  newness  of  the  art  of  flying,  the  tremendous 
strains  to  which  the  planes  were  subjected,  and  on 
top  of  this,  of  course,  the  risks  of  war.  It  was  danger- 
ous enough  just  simply  to  fly  in  most  weathers  with- 
out having  to  run  the  risk  of  being  potted  by  Archies 
and  other  anti-aircraft  guns,  to  say  nothing  of  enemy 
aviators. 

But  by  great  good  luck  the  doctor  was  finally 
called  in  consultation,  after  some  hundreds  of  the 
patients  were  already  dead,  and  it  was  discovered, 
much  to  every  one's  surprise,  that  a  very  large  share 
of  this  distressing  and  disabling  mortality  was  due, 
neither  to  the  enemy's  fire,  nor  to  engine  trouble,  nor 
to  defects  in  plane  construction,  but  to  accidents 
occurring  inside  the  flyer  himself.  A  joint  commission 
of  Allied  experts  was  appointed  to  investigate  a 
series  of  some  hundred  successive  deaths  of  airmen, 
and  reported  the  significant  and  astonishing  finding, 
that  a  very  large  percentage,  indeed  an  overwhelm- 
ing majority,  of  them  were  due  to  heart  failure,  loss 
of  consciousness,  or  other  sudden  breakdown  of  the 
aviator. 


THE  HEALTH  OF  THE  AVIATOR    385 

Here  evidently  is  most  promising  work  for  the 
doctor,  and  while,  of  course,  this  single  set  of  find- 
ings is  but  a  straw,  even  if  future  returns  from  our 
..  rapidly  widening  experience  should  cut  in  two  the 
tremendous  preponderance,  it  would  still  leave  the 
risks  of  air  fighting  chiefly  a  medical  problem;  as 
largely  so  almost  as  were  the  old-time  general  war 
mortalities  when  six  sevenths  of  all  deaths  in  an 
army  were  due  to  disease:  with  the  cheerful  out- 
look that  the  present  high  life-risks  of  the  flying 
man  may  be  cut  in  two,  if  not  to  a  fourth  or  a  fifth 
of  their  former  deadliness. 

At  all  events,  there  cannot  be  the  slightest  doubt 
that  all  the  possible  resources  of  medicine  and  the 
allied  sciences  should  be  immediately  called  into 
action  and  concentrated  on  the  problem  of  improving 
and  protecting  the  health  of  the  flying  man.  And  this 
is  why  army  doctors  have  been  so  eagerly  urging, 
what  has  just  recently  been  granted,  the  formation 
of  a  special  Aviation  Medical  Corps,  which  shall 
have  absolute  and  continuous  control  of  the  health 
and  welfare  of  the  aviator  from  the  time  that  he 
comes  up  for  admission  to  the  service  till  he  becomes 
a  candidate  for  the  wooden  cross  and  needs  * '  warn- 
ing off"  to  save  his  life. 

Although  these  findings  of  the  tremendous  part 
played  by  the  health  of  the  bird-man  in  his  death  risks 
astonished  even  the  doctors,  yet  it  fitted  in  with  and 


386  THE  DOCTOR  IN  WAR 

explained  a  number  of  other  rather  puzzling  results 
of  their  experience. 

One  was,  that  there  did  n't  seem  to  be  any  even 
approximately  ''accident-proof"  type  of  airman. 
No  matter  with  what  flying  colors  a  candidate  had 
passed  all  his  entrance  tests,  no  matter  how  swiftly 
he  became  at  home  in  the  air,  how  completely  he 
seemed  to  be  a  born  flyer,  for  whom  neither  altitude, 
nor  side  slips  nor  nose  dives  had  any  terrors,  sooner  or 
later,  one  day,  flying  under  perfect  air  and  weather 
conditions,  his  machine  would  be  seen  suddenly  to 
go  out  of  control  and  come  crashing  downward, 
either  to  a  fatal  smash  or  perhaps  to  recover  itself 
by  a  desperate  effort  within  fifty  or  a  hundred  feet 
of  the  ground. 

If  the  flyer  survived,  the  only  light  that  he  could 
throw  upon  the  accident  would  be,  perhaps,  that  he 
began  to  feel  sick  at  his  stomach  or  commenced  to 
turn  giddy,  or  that  his  machine  suddenly  seemed  to 
plunge  out  from  underneath  him,  or,  quite  frequently, 
that  he  remembered  nothing  at  all  from  the  time 
that  he  was  spinning  along  in  perfect  balance  until 
he  was  being  pulled  out  of  the  wreck  of  his  machine 
or  found  himself  in  a  hospital  cot. 

At  first  these  unaccountable  collapses  were  ascribed 
to  the  so-called  "holes  in  the  air,"  or  small  areas  of 
lower  density  In  the  atmosphere  due  to  vertical  up- 
ward or  downward  currents  of  air,  into  which  the 


THE  HEALTH  OF  THE  AVIATOR    387 

aeroplane  "bumped"  as  a  wagon  might  into  a  deep 
rut  or  chuck-hole.  But  it  seemed  rather  difficult 
to  prove  the  existence  of  such  pitfalls  on  other 
grounds,  and  even  if  they  existed  as  surmised,  they 
would  not  have  accounted  for  the  commonest  and 
most  constant  feature  in  the  aviator's  account  of  his 
mishap,  a  temporary  loss  of  memory  or  of  conscious- 
ness. 

Then  they  were  laid  to  a  mysterious  alleged  "air- 
sickness," similar  to  the  allied  and  familiar  sea- 
sickness, and  due  like  it  to  sudden  changes  and 
pitches  in  the  equilibrium  of  the  sufferer.  But  this 
again  was  found  to  be  largely  mythical,  certainly  at 
least  in  the  sense  of  its  being  an  experience  which  a 
majority  of  aviators  had  to  go  through  in  learning 
to  fly,  as  the  embryo  sailor  or  the  midshipman  has  to 
suffer  the  tortures  of  sea-sickness  before  he  acquires 
his  sea-legs.  When  we  came  to  send  up  flyers  by  the 
scores  and  the  hundreds,  it  was  soon  found  that  the 
majority  of  them  never  suffered  from  this  balancing 
"air-sickness'*  at  all  —  that  is  to  say,  not  until  they 
came  to  soar  to  high  altitudes,  when  they  encoun- 
tered "air-sickness"  of  another  sort;  while,  on  the 
other  hand,  expert  and  seasoned  flyers  would  be  sud- 
denly attacked  by  nausea  and  giddiness  without  any 
apparent  cause,  so  far  at  least  as  their  evolutions  or 
the  air  conditions  were  concerned.  In  fine,  all  we 
could  say  was  that  a  very  considerable  share  of  acci- 


388  THE  DOCTOR  IN  WAR 

dents  in  the  aviation  field  were  due  to  some  mysteri- 
ous cause  affecting  the  aviator  himself,  and  could 
not  apparently  be  accounted  for  by  plane  defects, 
weather,  or  the  stunts  which  he  was  attempting. 

Then  another  side-light  was  thrown  upon  the 
problem  from  a  grim  and  pathetic  angle,  and  that 
was  the  remarkable  frequency  with  which  aviators 
would  feel  and  express  premonitions  of  disaster  just 
before  going  up  for  their  final  and  fatal  flight.  Some- 
times it  would  be  a  mere  remark  to  some  of  his  com- 
rades or  officers,  that  he  believed  the  Boches  were 
going  to  get  him  this  time;  sometimes  the  statement 
that  he  had  n't  slept  very  well  and  had  had  dreams 
of  disaster,  or  that  his  head  was  feeling  queer  or  his 
stomach  uncomfortable,  and  he  did  n't  believe  he 
would  be  able  to  play  up  to  his  usual  standard  that 
day.  But  in  other  cases  the  premonitions  seemed  to 
have  been  so  definite  and  convincing  that  they  actu- 
ally left  letters  or  special  messages  for  their  relatives, 
or  even  instructions  to  their  comrades  as  to  what 
was  to  be  done  with  their  belongings  if  they  hap- 
pened to  be  "out  of  luck"  that  day. 

Of  course,  many  of  these  intimations  of  impending 
trouble  have  to  be  accepted  with  a  good  deal  of  cau- 
tion and  deduction.  Even  the  bravest  and  most 
expert  of  soldiers  or  other  men,  when  starting  out  to 
take  a  serious  risk,  have  attacks  of  depression  and 
foreboding,  most  of  which  come  to  nothing  at  all, 


THE  HEALTH  OF  THE  AVIATOR    389 

and  for  every  prophetic  or  "second-sight"  warning 
of  disaster  which  comes  true,  there  are  probably  at 
least  ten  or  a  dozen  which  happily  prove  entirely 
unfounded. 

But  we  doctors  have  gradually  come  to  regard  a 
sense  of  impending  death,  especially  early  in  a  case 
of  illness,  or  even,  as  sometimes  happens,  a  day  or  so 
before  the  disease  breaks  out  in  open  form,  from  a 
somewhat  different  point  of  view  than  that  of  pro- 
phecy or  "second  sight."  While  many  of  them  fortu- 
nately fail  to  come  true,  those  which  do  can  be  shown 
in  a  very  considerable  percentage  of  cases  to  rise  out 
of  the  state  of  mental  depression  caused  by  the  first 
flooding  of  the  patient's  blood  with  the  toxins  of  the 
disease.  In  other  words,  they  are  the  first  s3anptoms 
of  the  disease  itself,  instead  of  any  prophetic  intima- 
tion of  its  approach  beforehand. 

These  intimations  and  premonitions  of  the  avia- 
tors fall  very  decidedly  into  this  last  category  of 
coming  events,  which  literally  cast  their  shadows 
before  by  the  impression  that  their  first  and  advance 
attack  makes  upon  the  sensitive  nervous  system  of 
their  victims.  And  as  soon  as  we  began  to  question 
more  carefully  from  this  point  of  view  the  aviators 
whose  accidents  fortunately  did  not  prove  fatal,  we 
found  abundant  evidence  pointing  in  this  direction. 
One  flyer  had  noticed  that  he  had  n't  much  appetite 
for  breakfast,  and  what  little  food  he  ate  seemed  to 


390  THE  DOCTOR  IN  WAR 

disagree  with  him,  and  by  the  time  he  had  got  up 
only  a  few  thousand  feet  into  the  air,  he  became 
nauseated,  giddy,  and  momentarily  lost  control  of 
his  machine.  Another  complained  before  starting 
of  a  headache,  which  he  attributed  to  being  up  too 
late  the  night  before  or  perhaps  smoking  or  drinking 
a  little  more  than  he  should,  and  when  he  was  per- 
forming one  of  his  simplest  stunts,  his  head  began  to 
throb,  his  hands  seemed  to  become  numb,  and  his 
''bus"  went  out  from  under  him  —  and  landed  him 
in  the  hospital. 

The  higher  he  soars,  the  greater  becomes  the  mag- 
nification of  his  trouble,  so  that  apparently  a  dis- 
comfort or  disturbance,  which  would  have  been  no 
more  than  annoying  and  uncomfortable  if  he  had 
remained  on  earth,  is  multiplied  into  a  blinding  or 
disabling  disturbance  ten  thousand  feet  up. 

In  fact,  one  instance  at  least  has  been  furnished  of 
the  actual  demonstration  of  how  a  mere  trifling  dis- 
turbance on  the  ground  may  be  turned  into  a  serious 
interference  with  balancing  power  at  a  higher  alti- 
tude, in  one  of  our  Air  Board  laboratories.  It  has 
been  found  that  a  large  share  at  least  of  the  disturb- 
ances, dizzinesses,  etc.,  caused  by  high  altitudes,  is 
from  the  lack  of  oxygen  due  to  the  lowered  air  pres- 
sure. Consequently,  candidates  for  the  Flying  Corps 
can  be  tested  as  to  their  ability  to  stand  high  altitudes 
merely  by  putting  them  into  a  large  vacuum  chamber 


THE  HEALTH  OF  THE  AVIATOR    391 

and  gradually  exhausting  the  air  with  a  pump  to  the 
degree  of  thinness  which  would  be  found  at  an  alti- 
tude of  eight  thousand,  ten  thousand,  fifteen  thou- 
sand feet.  Two  expert  observers  usually  go  into  the 
vacuum  chamber  with  the  candidate  and  stand  one 
on  each  side  of  him  to  keep  track  of  the  pulse,  blood 
pressure,  and  general  condition,  so  as  to  give  warning 
when  he  is  approaching  any  danger  of  collapse ;  they 
being  supplied  with  tubes  in  their  mouths  through 
which  they  can  inhale  oxygen,  are  able  to  work  in 
almost  perfect  comfort.  And  it  is  quite  a  curious 
contrast  to  watch  the  labored  breathing  and  the  pale 
or  flushed  countenance  of  the  candidate,  as  the  pres- 
sure is  lowered,  while  the  experts  on  each  side  of  him 
remain  fresh-colored,  breathing  easily,  and  com- 
pletely absorbed  in  their  observations. 

But  one  morning,  one  of  the  observers  had  n't 
cared  much  for  his  breakfast,  and  what  he  did  eat 
did  n't  seem  to  agree  with  him,  and  after  he  had  been 
in  the  vacuum  chamber  with  one  candidate  after 
another  for  an  hour  or  so,  he  began  to  feel  an  un- 
comfortable sense  of  tightness  and  constriction  about 
his  waist-line.  Almost  without  thinking  what  he  was 
doing,  he  most  injudiciously  unbuckled  his  belt  and 
unbuttoned  the  two  upper  buttons  of  his  trousers, 
when  immediately,  under  the  extremely  low  pressure 
at  which  he  was  working,  his  stomach,  as  he  expressed 
it,  "bulged  up  like  a  balloon"  and  caused  him  such 


392  THE  DOCTOR  IN  WAR 

acute  discomfort  that  he  had  to  signal  to  be  let  out 
of  the  chamber. 

What  had  happened  was,  that  the  acid  fermenta- 
tion of  the  food  in  his  stomach  had  caused  the  pro- 
duction of  a  certain  amount  of  gas,  which  at  ordinary 
air  pressure  would  merely  have  made  him  slightly 
uncomfortable.  But  as  soon  as  the  pressure  of  the 
air  in  the  chamber  had  been  reduced  below  that 
of  the  gas  in  his  stomach,  it  proceeded  to  balloon 
up  and  cause  painful  distention  of  its  walls,  which 
might,  if  he  had  been  actually  flying  and  still  rising 
higher,  have  produced  very  severe  pain  and  even 
unconsciousness,  before  he  realized  what  was  the 
trouble. 

Of  late  the  same  tests  can  be  made,  without  the 
expense  and  trouble  of  a  vacuum  chamber,  by  al- 
lowing the  candidate  to  exhaust  the  oxygen  out  of 
the  air  of  a  container  by  simply  breathing  it  over 
and  over  again  till  its  rarity  corresponds  to  ten 
thousand,  fifteen  thousand,  twenty  thousand  feet  of 
altitude  and  noting  the  results. 

The  evidence  is  overwhelming  that  one  of  the  great 
mottoes  both  of  the  aviator  and  his  Army  doctor 
should  be,  *' Despise  not  the  day  of  small  things." 
The  same  gospel  was  already  being  preached  by  the 
experts  connected  with  our  Air  Board  laboratories 
and  testing-stations.  As  every  one  knows,  candidates 
for  admission  to  the  Flying  Corps  are  put  through 


THE  HEALTH  OF  THE  AVIATOR    393 

about  the  severest  "third  degree"  of  an  examination 
for  physical  fitness  that  can  well  be  imagined:  not 
merely  the  ordinary  Draft  Board  tests  for  soundness 
of  heart,  lungs,  limbs,  nerves,  and  senses,  but  a  whole 
battery  of  special  tests,  of  eyesight,  of  hearing,  of 
balancing  powers,  or  capacity  to  stand  high  altitudes, 
and  a  full  series  of  psychologic  tests  to  try  out  their 
mental  and  emotional  possibilities. 

In  the  beginning  and  for  a  considerable  time  after 
it  was  believed,  not  unnaturally,  that  the  aim  and 
result  of  all  these  tests  would  be  to  pick  out  among 
thousands  of  applicants  a  few  score  or  hundreds  of 
exceptional  men  peculiarly  fitted  for  the  new  and 
unconquered  field  of  the  air,  a  sort  of  human  bird, 
as  it  were,  men  who  did  n't  know  what  the  fear  of 
falling  was,  whose  balance  centers  or  semi-circular 
canals  could  not  be  disturbed  or  dizzied  by  any 
amount  of  whirling  blindfold  on  spinning  tables,  and 
who  would  not  gasp  for  breath  at  the  highest  alti- 
tudes, men  who  were  bom  to  fly  as  the  fish  is  to  swim. 

But  gradually,  as  experience  in  the  new  and  un- 
tried field  piled  up,  it  was  found,  first  of  all,  that  this 
type  of  bom  flyer  who  could  stand  any  amount  of 
altitude  and  whirling  and  looping  was  a  distinctly 
rara  aids  —  without  any  pun  being  intended.  Sec- 
ondly, that  when  this  fortunate  freak  or  prodigy  was 
discovered,  he  was  almost  as  liable  to  sudden  and 
unaccountable  accidents  and  mishaps  as  any  one  else. 


394  THE  DOCTOR  IN  WAR 

Third,  and  most  important,  that  any  vigorous, 
healthy,  intelligent  young  chap,  with  a  sound  heart, 
a  good  pair  of  lungs,  a  healthy  digestion,  and  normal 
eyesight,  hearing,  and  balancing  powers,  could  learn 
to  fly  within  ten  days  and  develop  into  a  perfectly 
competent  average  aviator.  To  make  an  ace  requires 
a  touch  of  genius,  but  for  nine  tenths  of  the  routine 
work  which  an  aviator  is  called  upon  to  do  —  bomb- 
ing, photographing,  observing,  fighting  in  regular 
formation  —  all  that  is  required  is  sound  health, 
keen  senses,  and  good  average  judgment  and  intelli- 
gence. "A  man  wid  two  hands  an'  two  feet  an'  all 
his  teeth  in  his  head,"  as  Mulvaney  puts  it.  The 
Navy  experts  frankly  declare  that  almost  any  man 
who  can  drive  an  automobile  can  learn  to  fly.  >. 
So  that  while  not  relaxing  the  thoroughness  of  their 
examination,  the  Air  Board  experts  are,  so  to  speak, 
rationalizing  their  standards,  feeling  that  they  will 
get  better  results  by  admitting  vigorous,  healthy,  nor- 
mal young  men,  putting  them  under  ideal  physical 
conditions  and  the  most  watchful  observation  of  the 
doctor,  and  then  completing  their  test  by  actual 
experience  in  the  air  itself.  First,  in  the  ** dummy" 
machines,  which  skim  about  in  all  directions  over 
the  field,  but  never  really  leave  the  ground  for  more 
than  a  few  yards  at  a  time;  then  in  a  double-seater 
with  an  experienced  pilot  and  coach,  and  weeding 
out  ruthlessly  those  who  do  not  quickly  become  at 


THE  HEALTH  OF  THE  AVIATOR    395 

home  in  the  air  and  lose  practically  all  fear  of  it  in  a 
week  or  ten  days,  or  who  seem  to  have  difficulty  in 
keeping  cool  and  clear-headed  and  meeting  easily 
and  enjoyably  the  ordinary  emergencies  of  simple 
flying. 

If  the  doctor  is  "strictly  on  the  job,"  the  risks  of 
this  preliminary  probation  would  be  slight,  and  it 
would  result  in  the  prompt  weeding-out  of  a  certain 
number  of  men  who  for  their  own  best  good,  as  well 
as  that  of  the  service,  ought  not  to  be  allowed  to  fly 
at  all.  It  seems  to  be  the  unanimous  opinion  of  avia- 
tion physicians  and  experts  in  all  the  Allied  countries 
that  there  is  a  certain  percentage  of  men  with  perfect 
physical  health,  and  who  can  pass  all  the  most  rigid 
tests  for  sight,  hearing,  balancing  powers,  etc.,  yet 
who  can  never  learn  to  fly  with  either  comfort  or 
safety.  If  this  type  were  keenly  watched  for  and 
promptly  weeded  out  within  the  first  two  or  three 
weeks,  and  the  much  larger  proportion  of  candidates 
who  take  to  the  air  easily  and  readily  were  kept  under 
constant  expert  observation,  and  never  permitted 
to  fly  either  in  training  or  actual  war  work  except 
when  they  were  in  perfect  physical  condition,  it  is 
believed  that  a  very  large  majority  of  the  fatal  risks 
of  flying  would  be  obviated  entirely. 

Most  aviators  of  experience  are  quite  well  aware 
of  the  dangers  of  going  up  when  not  physically  fit. 
They  enjoy  life  and  its  pleasures  as  keenly  as  any 


396  THE  DOCTOR  IN  WAR 

other  healthy,  high-spirited  youngsters,  but  most  of 
them  decline  to  smoke  when  on  active  service,  and 
many  of  them  abstain  from  alcohol  altogether  for 
days  before  a  flight,  or,  if  from  the  wine-growing 
countries,  take  only  most  abstemious  amounts  of  the 
lightest  of  vintages.  Though  they  are  left  almost 
entirely  to  their  own  discretion  in  these  matters,  they 
have  found  that  late  hours  and  burning  of  the  candle 
at  both  ends  of  all  sorts  simply  do  not  "consist "  with 
that  perfect  clearness  of  head  and  keenness  of  judg- 
ment which  is  absolutely  necessary  to  safe  and  suc- 
cessful flying. 

In  fact,  the  code  of  the  aviator  has  become  that  of 
the  athlete,  raised  to  the  ^th  power,  clean,  cheerful 
living,  self-restraint,  self-control,  well  repaid  by  the 
exhilarating  sense  of  fearlessness  and  fitness  for  any- 
thing. Their  chief  dread  is  of  nervous  exhaustion, 
which  shows  itself  in  the  form  of  worrying  and  lack 
of  confidence,  and  inability  to  judge  distances  prop- 
erly. Its  first  warning  symptoms  are  bad  dreams  and 
nightmares,  usually  connected  with  the  risks  of  their 
work,  among  which  machine  guns  jamming  and  two 
Boches  "diving  on  your  tail"  are  the  most  frequent 
and  significant.  When  these  visions  begin  to  make 
night  hideous,  they  know  that  their  only  safety  lies 
in  two  or  three  days  of  complete  rest.  Warnings 
which  come  in  dreams  are  usually  regarded  with  well- 
merited  suspicion,  but  in  this  particular  case  they 


THE  HEALTH  OF  THE  AVIATOR    397 

seem  to  be  painfully  liable  to  "come  true"  in  the 
shape  of  an  accident  or  mix-up,  if  their  danger  signal 
is  disregarded. 

Another  potent  way  in  which  the  safety  of  the 
bird-man  can  be  guarded  is  by  the  intelligent  use  of 
oxygen.  When  the  aviator  spirals  up  to  an  altitude 
of  eight  or  ten  thousand  feet,  he  comes  into  the 
danger  zone  of  what  has  long  been  known  as  "moun- 
tain sickness."  This  is  an  extremely  distressing  and 
uncomfortable  condition,  of  intense  depression  and 
sense  of  muscular  weakness  often  accompanied  by 
nausea,  vomiting,  and  giddiness,  which  attacks  those 
who  climb  high  mountain  peaks. 

Ever  since  men  began  to  climb  high  mountains  or 
to  go  up  in  balloons,  it  has  been  known  that  above 
a  certain  altitude  they  became  subject  to  various  dis- 
comforts, as  shortness  of  breath,  pain  in  the  ears, 
and  sensations  of  giddiness  from  changes  of  pressure 
upon  the  ear  drum,  and  hemorrhage  or  bleeding  from 
the  lips  and  throat  or  from  the  ears,  due  to  the  sudden 
lowering  of  the  pressure  upon  the  blood  vessels  near 
the  surface.  That  these  changes  were  due  to  the 
rarity  or  thinness  of  the  air  on  account  of  the  fact 
that  its  pressure  steadily  diminishes  as  one  climbs 
upward  from  the  sea-level  was  early  recognized,  but 
it  was  always  a  problem  as  to  how  much  of  it  was  due 
to  direct  action  of  the  lowered  pressure  upon  the 
body  surface  and  the  blood  in  the  blood  vessels,  and 


398  THE  DOCTOR  IN  WAR 

how  much  to  the  lowered  pressure  of  oxygen,  and 
consequently  smaller  amount  of  this  most  vital  gas 
which  could  be  drawn  into  the  lungs  at  each  breath. 

Recent  investigations,  however,  both  by  a  group 
of  American  scientists  in  their  famous  expedition  up 
Pike's  Peak,  and  by  Italian  and  French  experts,  have 
shown  that  the  lion's  share  and  probably  the  over- 
whelming majority  of  all  the  most  distressing  and 
disabling  of  these  symptoms  are  due  to  the  lack  of 
oxygen  alone  and  can  be  avoided  or  prevented  by 
judiciously  inhaling  a  supply  of  the  gas  from  a  cylin- 
der or  the  container.  This  is  a  finding  of  immense 
practical  importance,  because,  obviously,  if  what  has 
been  proved  in  high  mountain  altitudes  holds  good 
for  the  same  altitudes  in  aviation,  then  by  supplying, 
with  cylinders  of  oxygen  and  a  proper  inhaling  mask, 
all  flying  machines  which  are  expected  to  go  above 
eight  or  ten  thousand  feet,  another  very  considerable 
share  of  the  risks  and  dangers  of  high  flying  can  be 
either  prevented  entirely  or  very  considerably  dimin- 
ished. Experts  upon  both  sides  of  the  battle-line  are 
now  actively  engaged  in  testing  out  this  question 
and  in  devising  some  form  of  container  which  will 
combine  lightness  with  bullet-proofness,  and  an 
inhaling  tube  or  mask  which  will  properly  regulate 
the  supply  of  oxygen  for  the  airman. 

The  problem  is  a  diflicult  one,  partly  because  space 
in  the  narrow  body  of  the  fuselage  is  already  at  the 


THE  HEALTH  OF  THE  AVIATOR    399 

highest  possible  premium,  and  every  available  gap 
or  angle  of  the  airplane  is  packed  and  crowded  with 
controlling  or  fighting  or  protective  mechanical  de- 
vices of  every  imaginable  sort;  partly  because  the 
wearing  of  a  mask  through  which  to  inhale  the  oxy- 
gen would  be  likely  to  interfere  a  good  deal  with  the 
freedom  and  fighting  powers  of  the  airman,  while,  if 
inhaled  directly  through  a  tube,  it  would  have  to  be 
kept  flowing  at  very  low  pressure  or  else  considerably 
diluted  with  some  other  bland  gas,  in  order  to  pre- 
vent irritation  and  even  mild  burning  of  the  mouth 
and  throat. 

But  in  the  bright  lexicon  of  science  there  is  no  such 
word  as  fail,  and  if  it  is  shown  that  the  proper  use 
of  oxygen  will  prevent  much  of  the  stress  and  heavy 
wear  and  tear  of  flying  at  high  altitudes  with  frequent 
changes,  and  will  diminish  the  aggravation  of  com- 
paratively slight  disturbances  of  health  into  dis- 
abling distresses  high  up  in  the  air,  some  apparatus 
will  unquestionably  be  devised  for  supplying  our 
flyers  with  oxygen.  So  far  as  tests  conducted  in  the 
vacuum  chamber  on  the  ground  are  concerned,  it  has 
already  been  pretty  conclusively  proved,  both  by 
Italian  and  American  investigators,  that  at  least 
three  fourths  of  the  sensations  of  discomfort,  faint- 
ing, nausea,  etc.,  can  be  completely  prevented  and 
abolished  by  the  use  of  oxygen.  An  Italian  expert 
has  even  been  able  to  stand  with  perfect  comfort  a 


400  THE  DOCTOR  IN  WAR 

lowering  of  pressure  corresponding  to  an  altitude  of 
over  forty  thousand  feet,  simply  by  inhaling  a  gas- 
mixture  of  oxygen  and  carbon  dioxide,  the  other  gas 
which  is  present  in  our  blood.  This  elevation,  of 
course,  is  far  above  anything  ever  yet  achieved  by 
either  mountain  climbers  —  for  the  very  good  and 
sufficient  reason  that  there  isn't  anything  high 
enough  for  them  to  climb  on  to  that  level  —  or 
aviators. 

That  the  height  of  the  flying  has  a  marked  effect 
upon  the  risks  of  the  bird-man  is  most  strongly  sug- 
gested, if  not  actually  proved,  by  the  almost  appalling 
table  of  "life  expectation,"  worked  out  by  a  combina- 
tion of  English  and  American  air  experts,  of  the  dif- 
ferent classes  of  flyers.  At  the  top,  in  the  double 
sense  of  nearest  to  heaven  and  most  liable  to  ascend 
to  it  at  any  moment,  comes,  as  would  have  been 
expected,  the  combat  man  or  fighter,  who  has  to  fly 
at  heights  ranging  from  sixteen  to  twenty- two  thou- 
sand feet,  and  whose  average  "life"  is  from  one  hun- 
dred to  three  hundred  hours  of  actual  flying,  which 
means  from  one  to  three  months.  I  must  hasten  to 
explain,  however,  that  the  term  "life  "  does  not  mean 
the  literal  physical  life  of  the  aviator  himself,  but  the 
length  of  time  which  he  can,  as  the  saying  is,  last  in 
the  air,  after  which  he  is  extremely  likely  to  meet 
with  some  disabling  or  fatal  accident,  or,  if  his  guar- 
dian physician  and  superior  officers  are  properly 


THE  HEALTH  OF  THE  AVIATOR    401 

alert,  to  be  transferred  into  some  other  branch  of  the 
service  or  to  a  staff  position  or  a  post  as  instructor. 

Next  comes  the  observer  flying  at  from  ten  to  six- 
teen thousand  feet,  and  whose  "life"  is  considerably 
longer,  namely,  from  three  hundred  to  six  hundred 
hours  of  flying,  or  from  three  to  six  months.  Last  and 
safest  of  all  comes  the  night  bomber,  whose  particular 
task  requires  only  peaceful  altitudes  of  from  five  to 
ten  thousand  feet,  and  whose  ''life,"  though  less 
exciting,  is  noticeably  and  gratifyingly  longer,  namely 
from  seven  to  nine  months. 

Altogether,  the  outlook  for  the  flying  man,  the 
warrior  of  the  future,  is  very  much  less  serious  and 
more  hopeful  than  was  at  one  time  feared.  What  his 
actual  mortality  up  to  the  present  is  and  has  been  is 
jealously  preserved  as  a  military  secret,  so  that  it  is 
difficult  to  make  any  definite  prediction,  except  to 
say  that  we  may  confidently  expect  a  marked  reduc- 
tion of  it  in  the  near  future. 

First,  by  developing  a  system  of  aerial  medicine 
and  training  an  aviation  medical  corps,  and  put- 
ting the  welfare  and  the  interests  of  the  bird-man 
absolutely  and  entirely  under  their  control  from  the 
time  that  he  presents  himself  for  admission  to  the 
service.  Second,  by  improving  and  rationalizing  the 
present  series  of  tests  and  extending  it  to  include 
mental,  emotional,  and  judgmatic  powers,  and  giving 
each  candidate  a  thorough  practical  try-out  in  the 


402  THE  DOCTOR  IN  WAR 

air  under  the  most  vigilant  supervision,  both  med- 
ical and  aeronautic,  before  deciding  upon  his  admis- 
sion or  rejection.  Third,  by  the  utilization  of  oxygen 
as  a  preventive  of  some  of  the  most  serious  risks  of 
air-sickness  and  other  conditions  liable  to  cause  loss 
of  consciousness.  Last,  but  not  least,  by  having  the 
aviation  doctor  live  with  and  "mother"  him  as  a 
trainer  does  with  his  crew  or  team ;  watching  him  like 
a  hawk  for  the  slightest  appearance  of  trouble  or 
deviation  from  normal  balance,  and  then  absolutely 
forbidding  him  to  fly  except  when  in  perfect  condi- 
tion. This  will  mean  the  having  in  reserve,  as  it 
were,  a  somewhat  larger  number  of  men  for  each 
given  number  of  machines,  so  as  to  be  sure  that  there 
will  always  be  a  sufficient  number  of  competent  flyers 
in  proper  condition  for  flight.  But  there  can  be  no 
question  that  it  will  result  in  the  checking  of  a  most 
pitiful  waste  of  splendid  young  life  and  the  reduction 
of  the  risks  of  the  bird-man  in  his  new  element  to  less 
than  half  if  not  less  than  one  fourth  of  their  present 
level. 


XXII 

THE  UNIVERSITY  OF  THE  ARMY:  WAR 
AS  A  COLLEGE  COURSE 

WAR  is  the  oldest  game  in  the  world,  but  the 
rules  are  always  changing.  On  account  of  its 
dramatic  appeal  and  our  age-long  ancestral  worship 
of  courage  as  the  supreme  virtue,  our  imagination 
persists  in  thinking  of  the  war  game  as  if  it  were  still 
played  according  to  the  rules  of  the  last  century  or 
the  century  before  last. 

So  deeply  have  historic  and  other  forms  of  roman- 
tic literature  impressed  upon  our  mind's  eye  the 
picturesque  aspects  of  warfare  that  we  simply  cannot 
rid  ourselves,  in  spite  of  the  evidence  of  our  senses, 
of  the  idea  of  war  as  a  matter  of  flying  colors  and 
glittering  accoutrements  and  dashing  cavalry  charges 
with  waving  of  swords  and  shouting  of  war-cries. 

When  we  send  forth  our  boys  to  do  their  part  in 
making  the  world  safe  for  democracy  and  keeping 
life  worth  living  in  the  future  for  those  who  would  be 
free,  we  are  apt  to  think  of  them  as  going  into  a  world 
totally  different  from  their  past,  where  their  sole  aim 
and  occupation  will  be  risking  their  lives  trying  to 
kill  other  men  or  to  keep  other  men  from  killing  them. 
Something  which  has  not  only  no  connection  with 


404  THE  DOCTOR  IN  WAR 

their  past,  but  no  bearing  upon  or  relation  to  their 
future  life  and  work  after  the  war  is  over. 

As  a  matter  of  actual  fact,  probably  less  than  ten 
per  cent  of  their  time  will  actually  be  occupied  in  the 
dangerous  and  exciting  duty  of  actual  fighting.  And 
while  the  whole  of  their  training  and  cooperative 
activity  and  mental  teamwork  is  directed  toward 
*'this  brief,  fierce  hour  of  glorious  life"  and  getting 
the  better  of  the  enemy,  yet  the  means  which  are 
employed  in  leading  up  to  this  crushing  blow  on  the 
enemy's  lines  are  the  very  latest  and  most  up-to-date 
forms  of  modem,  industrial,  and  social  organization 
and  scientific  efficiency. 

Modern  war  has  become  one  vast  engineering  and 
reclamation  enterprise  with  a  fighting  edge  on  it. 
Every  human  faculty  and  gift  and  power  which  is 
useful  in  peaceful  life  will  find  its  field  and  scope  and 
occupation  in  modern  war.  As  Sir  Auckland  Geddes, 
England's  Director  of  National  Service,  has  recently 
put  it,  **  Every  man  who  is  capable  of  earning  a  living 
in  peaceful  life  can  be  made  use  of  in  a  modern  army.'* 

In  the  first  days  of  the  war,  when  the  crying  need 
was  to  rush  forward  some  sort  of  a  human  barrier 
against  the  devouring  Prussian  flood,  there  was  no 
time  for  making  distinctions  of  capacity  and  special 
fitness.  Any  one  who  was  brave  enough  to  offer  his 
life  for  the  defense  of  his  country,  and  physically  fit 
and  vigorous,  was  eagerly  and  gladly  accepted,  and 


THE  UNIVERSITY  OF  THE  ARMY    405 

sent  out  to  the  firing-line  with  as  brief  a  delay  as 
possible  for  obtaining  an  equipment.  But  as  soon  as 
the  war  had  settled  down  into  its  form  and  the  real 
nature  of  the  seriousness  of  the  struggle  became  ap- 
parent, an  actual  combing-out  had  to  be  made  of  the 
regiments  on  service  at  the  Front  for  the  puipose  of 
bringing  back  the  men  who  had  special  mechanical, 
engineering,  and  scientific  training,  for  the  purpose 
of  putting  them  into  munition  factories  and  on  the 
railroads  and  on  the  telephone  and  telegraph  lines 
supplying  and  supporting  the  armies  at  the  Front. 

So  new  and  unforeseen  was  this  demand  of  modem 
war  that  even  in  Germany  hundreds  of  thousands  of 
men  were  withdrawn  from  active  service  at  the  Front 
to  go  back  to  munition  factories,  electrical  and  chem- 
ical works,  and  later  even  to  special  branches  of  agri- 
culture, in  order  to  keep  the  fighting-line  supplied 
with  the  sinews  of  war.  As  Lloyd  George  declared 
not  long  ago  in  Parliament,  "It  takes  three  and  four 
women  at  home  on  the  land,  in  the  mines,  in  the  shops, 
and  on  the  railroad  to  maintain  and  supply  one  man 
on  the  fighting  line  at  the  Front." 

Nowadays  when  a  man  is  enlisted  or  conscripted 
for  service  a  careful  inquiry  is  made  as  to  his  previous 
training,  experience,  and  aptitude,  so  as  to  see  for 
what  particular  group  of  the  innumerable  callings 
which  go  to  make  up  the  modern  army  he  is  best 
fitted.    If  he  knows  how  to  run  and  repair  a  car,  he 


406  THE  DOCTOR  IN  WAR 

will  very  probably  be  enlisted  at  once  in  one  of  the 
various  branches  of  the  transportation  service.  Next 
to  the  railways  long  lines  of  motor  lorries  and  trucks 
bearing  food,  supplies,  and  ammunition  are  the  literal 
life-blood  of  an  army,  without  which  its  striking  mus- 
cles would  quickly  fall  paralyzed  and  helpless. 

If  he  has  had  experience  in  the  Big  Woods  he  may 
be  drafted  into  one  of  the  army  lumbering  gangs, 
which  with  portable  sawmills  are  invading  the  ancient 
forests  and  woodlands  of  France  and  cutting  down 
and  sawing  up  the  monarchs  of  its  glades  to  make 
barracks  and  sidewalks  and  trench  revetments  for 
the  Allied  troops.  Thousands  of  Canadian  lumber- 
jacks have  been  specially  enlisted  in  the  Army  for 
this  purpose,  and  you  hear  the  whirr  of  their  saws 
and  the  ringing  of  their  axes  in  the  historic  woods 
and  beautiful  groves  all  over  England,  sacrificing  the 
oaks  of  the  Druids  and  the  sheltering  groves  of  the 
noblest  mansions,  for  the  defense  of  freedom. 

Should  he  have  had  familiarity  with  electrical 
installations  or  with  telephone  or  telegraph  work, 
there  is  a  whole  range  of  berths  in  these  Intelligence 
and  Signal  Services  which  are  open  to  him.  Not  only 
are  new  lines  of  communication  being  constantly 
built,  but  unlike  in  civil  life  the  old  lines  will  not  stay 
put,  but  are  continually  being  destroyed  and  inter- 
rupted so  that  a  continuous  exercise  of  ingenuity  in 
reconstruction  is  constantly  necessary. 


THE  UNIVERSITY  OF  THE  ARMY    407 

If  he  knows  anything  about  pumps,  or  mining,  or 
drainage  or  water-supply,  he  will  be  eagerly  snapped 
up  by  either  military  engineers  or  sanitary  officers 
and  employed  upon  vitally  important  military  serv- 
ice, even  though  it  has  nothing  directly  to  do  with 
participation  in  the  actual  fighting. 

Has  he  "an  eye  for  country"  or  some  experience 
in  surveying  and  knows  how  to  draw  maps  and  plot 
out  contour  lines,  there  is  a  wide  field  for  him  in  the 
surveying  department  of  the  various  headquarters 
staffs. 

Should  he  prove  an  adept  in  the  greatest  and  most 
important  of  all  arts,  the  handling  and  moulding  and 
controlling  of  men,  there  are  a  score  of  eyes  constantly 
upon  him  to  detect  the  first  blossoming  of  ability  in 
this  direction.  And  his  rise  in  rank  on  an  average 
will  be  found  to  be  as  rapid  and  as  free  from  personal 
favoritism  as  in  any  business  or  occupation  at  home. 
Not  only  is  every  officer  worth  his  salt  eager  to  get 
the  best  and  most  competent  non-commissioned  offi- 
cers that  he  can  find  among  his  men,  but  there  is  also 
now  a  formal  Army  order  in  both  the  British  and  the 
French  forces  requiring  each  and  every  colonel  to 
recommend  every  three  months  a  certain  minimum 
number  of  men  and  non-commissioned  officers  from 
the  ranks  of  his  regiment  for  promotion  to  a  cadet- 
ship  in  the  Officers'  Training  Corps. 


4o8  THE  DOCTOR  IN  WAR 

A  modern  army  in  the  field  is  a  complete,  perfectly 
organized,  self-contained,  bachelor  community.  Save 
for  the  fact  that  all  its  members  are  vowed  to  tem- 
porary celibacy,  the  whole  length  of  the  Western 
Front  is  like  one  continuous  industrial  village  or 
model  suburb,  with  all  the  mills  running  at  full  blast 
day  and  night.  With  all  its  hatefulness  and  hardships 
trench  warfare,  instead  of  being  a  round  of  dull  and 
dreary  outpost  duty,  with  monotonous  killing  of 
time  in  comfortless  camps,  is  one  constant,  busy, 
enterprising  push  and  struggle  against  the  enemy, 
with  all  the  methods  and  resources  of  modern  science, 
as  active,  as  bustling,  as  resourceful,  and  far  more 
interesting  and  exciting,  than  even  successful  indus- 
trial business  or  professional  life  in  peaceful  times  at 
home. 

There  are  as  many  different  trades  and  occupa- 
tions running  full  blast  in  the  war  zone  as  there  are 
in  an  urban  community  at  home,  and  all  of  them  plied 
by  soldiers.  The  War  Department  recently  adver- 
tised for  men  urgently  wanted  for  the  needs  of  the 
Army,  skilled  in  sixty-six  different  trades!  "Tinker, 
tailor,  soldier,  sailor,  rich  man,  poor  man,  beggar 
man,  thief,  doctor,  lawyer,  Indian  chief,"  with  the 
delightful  and  refreshing  exception  that  there  is 
neither  ''poor  man,  beggar  man,  nor  thief*'  in  the 
war  democracy.  The  only  articles  of  property  which 
Tommy  or  Alphonse  seems  to  be  in  the  least  afraid 


THE  UNIVERSITY  OF  THE  ARMY    409 

of  losing  in  camp  are  dogs,  war  relics,  and  pipes, 
which  are  regarded  as  ''wild  game,"  like  umbrellas 
and  watermelons  at  home. 

"Tinkers"  are  legion  both  in  numbers  and  kinds, 
for  the  wearing-out  and  breaking-down  of  every  kind 
of  a  plant  and  equipment  in  war  is  from  five  to  ten 
times  as  rapid  as  in  peace,  and  a  man  who  has  a  craft 
or  a  natural  gift  in  any  and  every  imaginable  variety 
of  the  repairing  and  reconstructing  line,  from  the 
cobbling  of  shoes  and  mending  of  belts  up  to  the 
straightening  of  rifle-barrels  and  the  curing  of  engine 
troubles  in  autos,  or  of  the  intestines  of  howitzers,  or 
the  rejuvenation  of  "  driven-down "  airplanes,  can 
find  abundant  and  constant  occupation.  The  life  of 
a  magazine  rifle,  for  instance,  in  actual  service  is  said 
to  average  about  two  to  three  months;  that  of  a 
motor  on  war  duty  about  six  weeks. 

The  whole  purpose  of  the  steady  cataract  and 
avalanche  of  enemy  shells  poured  upon  our  lines 
every  day  of  the  week  and  every  week  of  the 
month,  is  to  fill  up  and  obliterate  trenches  faster 
than  they  can  be  dug  out  again.  Hence  everybody 
in  the  trenches  works,  constantly  thickening  bomb- 
proofs  and  dug-outs,  strengthening  their  roofs, 
and  burrowing  more  deeply  underground,  to  keep 
himself  shell-proof;  the  moment  you  quit  you're 
"snowed  under." 

The  so-called  fixity  and  rigidity  of  trench  warfare 


410  THE  DOCTOR  IN  WAR 

is  in  one  sense  only  apparent.  Armies  to-day  have  to 
work  harder  to  stay  in  one  place  than  armies  of  the 
open  warfare  of  yesterday  had  to  advance  a  hundred 
miles.  The  mere  repair  and  upkeep  of  the  trenches 
for  the  firing-line  and  of  dug-outs,  bomb-proofs,  and 
underground  galleries  for  the  troops  in  support  be- 
hind the  third  trench,  will  occupy  a  third  of  the  total 
man-power  of  the  army.  A  trench  is  literally  moulded 
upon  and  supported  by  the  bodies  of  men,  and  is 
perpetually  changing  and  growing  like  a  live  thing. 
It  has  to  fit  the  bodies  of  the  men  who  occupy  it  like 
the  cell  of  the  honeycomb  does  the  working  bee. 
Roughly  speaking,  it  can  be  only  six  inches  deeper 
than  the  height  of  the  tallest  man  in  it,  and  about  six 
inches  wider  than  double  the  depth  of  his  body  from 
chest  to  back.  Most  first-line  trenches  are  dug  just 
wide  enough  for  the  men  to  be  able  to  glide  past  one 
another  by  turning  sideways. 

They  must  fit  the  holding  troops  like  a  suit  of 
clothes.  If  they  are  too  shallow,  obviously  the  heads 
of  the  men  will  be  exposed  to  the  horizontal  flying 
fragments  of  shells  which  strike  on  the  surface  in 
front  or  behind  them.  If  they  are  more  than  a  foot 
above  the  heads  of  the  men,  there  is  danger,  when  a 
big  shell  crushes  in  the  front  wall,  of  burying  them  so 
deeply  that  they  will  be  unable  to  dig  their  own  way 
out.  Their  extraordinary  and  inconvenient  narrow- 
ness is  due  to  the  stern  mathematical  fact  that, 


THE  UNIVERSITY  OF  THE  ARMY    411 

whereas  the  only  shells  that  can  inflict  serious  and 
extensive  damage  on  the  men  are  those  which  fall 
directly  in  the  trench,  obviously  a  trench  which  is 
three  feet  wide  is  just  twice  as  dangerous  as  one 
which  is  only  eighteen  inches,  and  greater  widths  in 
proportion. 

Front  trenches  cannot  be  lined  or  strengthened  to 
any  considerable  extent  with  stone  or  iron  plates,  or 
even  wood  or  cement,  for  the  reason  that  while  men 
can  work  their  way  out  or  be  dug  out  from  under  a 
foot  or  even  two  feet  of  loose  earth  before  they  are 
smothered,  it  is  a  much  more  serious  and  dangerous 
matter  if  the  cave-in  carries  with  it  beams,  or  stones 
or  iron  plates  to  trap  and  crush  bodies  and  limbs; 
while  in  the  case  of  stone  and  wood  the  splinters 
which  will  be  sent  flying  by  a  shell-burst  may  be 
almost  as  dangerous  as  the  fragments  of  the  shell 
itself. 

If  the  men  are  left  entirely  to  themselves,  they 
have  a  natural  and  pardonable  tendency  to  burrow 
steadily  deeper  on  ''Safety  First"  principles,  al- 
though this  again  is  considerably  checked  by  the  like- 
lihood of  striking  ground-water  in  most  soils  when 
you  get  below  a  moderate  depth.  The  champion  per- 
formance in  this  line  which  I  saw  was  that  of  a  canny 
and  elderly  French  regiment,  which  had  held  trenches 
in  a  firm,  well-drained  soil  for  many  months,  and 
had  gradually,  almost  unconsciously,  lowered  them 


412  THE  DOCTOR  IN  WAR 

to  the  luxurious  depth  of  eleven  feet  so  that  they  had 
to  use  ladders  to  get  up  on  to  the  fire-step !  But  this 
was  an  eccentricity,  and  the  bitter  experience  of 
years  of  actual  warfare  has  clearly  shown  that  deep 
trenches,  in  spite  of  their  comfort  and  sense  of  se- 
curity, like  too  deep  and  elaborate  dug-outs  and 
underground  chambers,  have  proved  more  danger- 
ous as  traps  for  the  burying  and  suffocating  of  whole 
bodies  of  troops  or  for  their  capture  as  prisoners 
than  helpful  in  protecting  against  shell-fire. 

In  short,  human  bodies  holding  and  moving  about 
in  shallow  runways  in  the  soft  surface  of  Mother 
Earth  have  proved  the  only  real  fortifications  in 
modern  war,  the  only  barrier  which  can  defy  the 
terrors  and  check  the  advance  of  the  hugest  guns 
and  the  highest  explosives. 

So  that  the  term  spent  in  the  front-line  trenches 
is  not  just  simply  a  period  of  vigilance,  hardship,' 
and  passive  exposure  to  danger,  but  one  of  almost  in- 
cessant repair  and  construction  and  extension.  No 
trench  feft  to  itself  would  last  forty-eight  hours  under 
modern  shell-fire.  The  same  is  true  even  in  a  higher 
degree  of  the  much  longer  period  spent  in  reserve  and 
rest  camps  behind  the  lines.  On  account  of  the  extra- 
ordinary range  of  modern  big  guns  and  of  the  tre- 
mendous part  played  by  bomb-dropping  airplanes, 
the  destruction  which  is  being  incessantly  wrought 
far  behind  the  lines  upon  camps,  barracks,  shelters, 


THE  UNIVERSITY  OF  THE  ARMY    413 

and  villages,  railheads,  hospitals,  roads,  and  light 
railways  by  enemy  fire  is  second  only  to  that  in  the 
front-line  trenches  themselves.  This,  added  to  the 
natural  effects  of  the  elements,  makes  incessant  re- 
pair and  reconstruction  the  standing  orders  of  the 
day.  And  to  suppose  that  time  hangs  heavy  upon 
the  hands  of  the  soldiers,  even  in  reserve  and  rest 
camps,  would  be  a  great  mistake. 

On  the  contrary,  so  active  have  become  the  de- 
mands of  enthusiastic  officers,  with  a  keen  eye  for 
repairs  and  improvements,  especially  since  road- 
building  and  agriculture  have  been  added  to  the 
regular  military  duties  of  an  army,  that  the  soul  of 
Mr.  Thomas  Atkins  has  been  seriously  and  resent- 
fully disturbed.  He  left  his  happy  home  and  came 
out  to  France  to  fight,  not  to  plough  fields  and  dig 
ditches  and  build  roads  and  bridges  and  model 
barracks. 

I  was  actually  told,  on  one  section  of  the  Front 
in  Flanders  that  I  visited,  that  the  men  had  sent  a 
delegation  to  the  general  commanding  asking  to  be 
allowed  to  spend  more  time  in  the  front  trenches  and 
less  in  rest  and  reserve  camps,  where  these  irksome 
and  degrading  fatigue  duties  were  demanded  of  them 
from  morning  to  night!  This  is  interesting  both  as 
showing  what  an  active,  busy  life  the  modern  sol- 
dier's has  become,  and  second,  how  lightly  the  sea- 
soned soldier  holds  the  horrors  of  modern  shell-fire 


414  THE  DOCTOR  IN  WAR 

and  the  rack  and  agony  of  that  terrible  modern  war 
strain  which  we  hear  so  much  talk  about. 

Scarcely  an  aptitude  or  capacity  of  the  human  life 
can  be  imagined  which  cannot  be  given  full  play  and 
scope  in  the  industrial  democracy  of  modern  war. 
Indeed,  it  would  hardly  be  too  much  to  say  that  the 
man  who  is  just  plain  fighting  man  and  nothing 
else  is  the  exception  and  not  the  rule.  Not  only  is 
there  this  wide  range  of  opportunity  for  development 
from  the  general  and  the  doctor  and  the  judge  down 
to  the  cobbler,  the  tailor,  and  the  cook,  but  each  one 
of  these  has  its  open  and  recognized  line  of  promotion 
and  advancement  to  almost  any  degree  of  author- 
ity and  usefulness.  The  leading  positions  in,  say, 
the  commissariat  department,  in  the  army  service 
corps,  in  the  quartermaster's  service,  in  the  con- 
struction and  engineering  department,  are  as  influ- 
ential and  honorable  and  as  well  paid  as  almost 
anything  in  the  pure  line  itself. 

To  become  a  member  of  a  great  community  of  serv- 
ice, sinking  individual  and  selfish  interests  in  devotion 
to  a  common  end,  is  in  itself  a  wonderfully  broaden- 
ing experience  and  a  liberal  education.  Although 
organized  for  destructive  instead  of  constructive  pur- 
poses, the  atmosphere  that  one  becomes  keenly  con- 
scious of  in  the  great  military  democracy  of  the 
Front  is  one  almost  Utopian  in  its  justice,  its  fairness, 
and  its  eagerness  for  mutual  helpfulness  and  service. 


XXIII 

THE  ARMIES  AT  PLAY 

LAUGHTER  is  to  the  spirit  what  sunshine  is  to 
the  air;  neither  can  keep  sweet  without  it.  And 
the  soldier  must  laugh  even  oftener  than  the  civilian, 
because  his  life  is  harder  and  more  dangerous.  He 
has  so  much  of  the  bracing,  stinging  frost  of  danger 
and  of  the  dreary,  chilly  rain  and  sleet  of  hardship, 
that  he  must  have  frequent  periods  of  the  sunshine 
of  laughter  and  enjo>TTient,  or  stiffen  and  sour  under 
the  strain. 

The  thing  that  brings  home  most  forcibly  to  the 
visitor  at  the  Front  that  a  modern  army  camp  is  a 
full-blown,  self-supporting  community,  a  real  city 
under  canvas,  or  town  under  tar-paper,  is  neither  its 
size,  which  is  often  that  of  a  State  capital,  nor  its 
steam  laundry,  its  huge  dining-halls,  its  wooden  side- 
walks, its  general  store,  its  tobacco  and  candy  shops, 
its  soda-water  fountains,  its  bank  and  express  office. 
It  is  the  fact  that  its  largest  building  is  a  moving-pic- 
ture theater  and  concert-hall,  its  most  attractive  out- 
of-door  space,  the  primitive  little  platform  or  ''play- 
ers' pitch,"  with  booth-like  dressing-rooms  set  at  the 
foot  of  a  circling  rise  of  the  ground,  or  in  the  hollow  be- 
tween two  hills,  so  as  to  face  a  natural  amphitheater, 


4i6  THE  DOCTOR  IN  WAR 

where  plays  and  open-air  spectacles,  or  lectures  and 
patriotic  addresses  can  be  given  to  three  or  four 
thousand  soldiers  at  once. 

Next  after  these  come  the  football  field,  and  in  an 
American  camp  the  baseball  ground  and  stand — ■ 
though  ''grand  '*  it  could  hardly  be  called.  Then,  as 
one  watches  the  streams  of  bright-eyed,  vigorous 
humanity  which  pour  through  the  streets  of  the 
army  town  after  the  bugles  have  blown  in  the  after- 
noon for  rest  and  play  and  follows  the  principal  cur- 
rent, one  quickly  comes  to  that  matchless  soldiers' 
club  and  refuge  of  homesick  hours,  the  Y.M.CA. 
Hut.  This  "hut "  is  a  rough  but  comfortable  wooden 
hall  from  forty  to  eighty  feet  long,  where  concerts 
and  lectures  and  "chalk-talks"  and  "sing-songs" 
and  "smokers"  are  the  continual  order  of  the  day, 
or  rather  of  the  night.  Classes  in  French  and  his- 
tory and  literature  and  chemistry  and  other  sci- 
ences are  provided  for  the  educationally  disposed, 
and  manly,  kindly,  practical  talks  on  applied  Chris- 
tianity, with  the  dear  old  familiar  hymns.  The  offi- 
cers of  the  regiment,  the  Colonel,  the  Quartermaster, 
the  Doctor,  come  in  and  talk  with  the  young  soldiers 
in  an  unofficial  capacity,  so  to  speak,  giving  them 
fatherly  advice  and  information  on  the  standards, 
the  high  traditions,  the  duties  and  the  temptations, 
the  glory  and  the  rewards,  of  a  soldier's  life. 

How  popular  and  well  appreciated  they  are  may 


THE  ARMIES  AT  PLAY  417 

be  glimpsed  from  the  fact  that  the  only  complaint 
which  one  eager  young  secretary  made  to  me  was  the 
smiling  one  that  the  hall  was  n't  big  enough  to  hold 
half  the  crowd  that  wanted  to  get  in  to  the  talks  and 
concerts,  and  that  the  ''overflow"  would  insist  on 
crowding  every  window  so  full  of  heads  as  almost  to 
cut  off  the  supply  of  air  for  those  inside. 

Between  entertainments  the  hall  is  filled  with  little 
tables  for  writing  home,  reading,  and  playing  games, 
a  good  supply  of  newspapers,  magazines,  and  recent 
books  being  kept  on  hand.  Nor  are  creature  comforts 
by  any  means  neglected:  each  hut  has  an  excellent 
canteen  and  lunch-counter,  where  soft  drinks,  hot 
coffee,  pie,  eggs,  sweet-stuffs,  and  other  home-like 
delicacies,  not  included  in  the  Army  ration,  are  sup- 
plied all  through  the  afternoon  and  evening.  The 
prices  are  very  moderate  and  any  profit  which  may 
be  made  is  applied  to  the  upkeep  of  the  hut. 

In  our  American  camps  these  Y.M.C.A.  Huts  are 
supplemented  by  regimental  canteens  with  reading- 
and  writing-rooms,  and  in  the  English  camps  there 
are  either  Church  Army  Huts  or  Salvation  Army 
Huts,  with  similar  equipment  and  programmes,  only 
with  not  so  many  concerts  and  lectures  and  educa- 
tional features.  All  these  organizations  are  doing 
most  valuable  and  devoted  work,  and  it  need  hardly 
be  said  that  those  of  religious  character  and  spirit, 
while  stanchly  true  to  their  ideals,  are  magnificently 


4i8  THE  DOCTOR  IN  WAR 

''long"  on  human  helpfulness,  home-like  sociability 
and  comfort,  wholesome  amusement  and  intelligent 
recreation,  and  mercifully  short  on  formal  theology 
and  nice  dividings  of  doctrine. 

The  only  approach  to  any  display  of  doctrinal 
prejudice  was  the  resentful  and  spontaneous  out- 
burst on  the  part  of  a  peppery  old  General  when  re- 
quested to  provide  quarters  for  the  Salvation  Army: 
to  the  effect  that  he  'd  be  hanged  if  he  'd  submit  to  the 
idea  getting  abroad  that  the  soldiers  of  his  division 
were  bad  enough  to  need  converting  by  hallelujah 
methods!  This,  of  course,  is  a  matter  of  individual 
opinion,  but  after  one  has  actually  seen  a  few  hun- 
dred thousand  fighting  men  of  this  war  on  the 
Front  and  found  what  manly,  kindly,  self-controlled, 
splendid  fellows  they  are,  one  begins  to  feel  a  dis- 
tinct sympathy  with  the  good  General's  resentment. 

And  when  the  Salvation  Army  actually  got  into 
the  war  it  proceeded  to  play  pies,  doughnuts,  and  hot 
coffee  under  fire  as  its  "long  suit,"  with  kindliest 
fatherly  advice  and  assistance  and  motherly  care 
and  services  instead  of  cymbals  and  hallelujahs. 
Few  agencies  have  got  closer  to  the  hearts  of  our 
boys  in  France  than  the  Salvation  Army. 

It  would  be  hard  to  speak  too  highly  of  the  splendid 
services  rendered  by  the  Y.M.C.A.  on  both  the  Eng- 
lish and  American  Fronts.  What  the  military  author- 
ities and  the  Government  themselves  think  of  it  may 


THE  ARMIES  AT  PLAY  419 

be  seen  from  the  fact  that  one  of  its  chief  secretaries 
in  London,  Sir  Arthur  Yapp,  was  knighted  over  a 
year  ago  and  has  since  been  asked  to  assume,  in  addi- 
tion to  the  secretarial  and  Army  Camp  duties,  the 
leadership  of  the  great  food  economy  campaign,  so 
that  he  has  become  one  of  the  most  prominent  and 
influential  men  in  England. 

The  courses  of  lectures  and  concerts  and  other 
entertainments  are  by  no  means  limited  to  local  tal- 
ent or  chance  volunteers.  On  the  contrary,  a  regular 
entertainment  bureau  has  been  organized,  which 
secures  not  only  lecturers  and  entertainers  from  all 
over  the  United  Kingdom,  but  also  prominent  min- 
isters, lawyers,  doctors,  and  scientists,  who  are  sent 
out  on  regular  tours  of  speaking  and  lecturing  all 
along  the  Front  and  through  the  Training-Camps  at 
home.  Some  of  the  ablest  speakers  and  writers  vol- 
unteer gladly  for  this  service,  and  it  is  hardly  too 
much  to  say  that  the  average  soldier,  unless  he  has 
come  from  a  great  metropolitan  center,  has  a  finer 
or  better  opportunity  to  see  and  hear  the  best  and 
most  worth-while  of  both  men  and  ideas  than  he 
could  have  had  in  his  own  home  neighborhood. 

But,  as  if  even  this  were  not  enough,  about  the 
second  year  of  the  war  there  came  a  demand  from 
the  men  themselves  for  even  more  serious  and  sys- 
tematic information  and  instruction.  I  was  greatly 
interested  to  find  last  spring  that  the  English  Govern- 


420  THE  DOCTOR  IN  WAR 

ment  was  sending  out  to  the  camps  at  the  Front  some 
of  its  greatest  teachers  and  leading  authorities  in  all 
sorts  of  fields,  such,  for  instance,  as  naval  affairs,  the 
problem  of  modern  aeronautics,  international  law, 
modern  history,  chemistry,  French  and  English  liter- 
ature, and  arranging  for  them  to  give  short  courses 
of  lectures  in  their  special  subjects,  followed  for  those 
who  wished  it  by  a  sort  of  University  Extension 
examinations.  Just  to  mention  a  few  of  the  best- 
knowTi  names:  Mr.  H.  G.  Wells,  Professor  Arthur 
Pollen,  the  naval  expert.  Professor  Gilbert  Murray, 
Dr.  Frederic  W.  Mott,  the  famous  pathologist,  and 
Sir  Frederick  Treves,  one  of  the  surgeons  to  the  Royal 
Family,  and  other  men  of  like  caliber. 

On  the  athletic  side  of  its  play  an  English  or 
American  Army  Camp  is  like  a  well-organized  college 
or  high  school.  In  the  first  place,  while  the  great 
movements  of  the  armies  are  on  the  most  massive 
and  formal  scale,  there  is  a  surprising  amount  of 
scope  left  for  individual  initiative  and  ingenuity  of 
junior  officers,  sergeants,  and  even  the  men  them- 
selves, in  planning  and  carrying  out  those  innumer- 
able little  private  entertainments  and  local  vendettas 
known  as  raids,  patrolling  movements,  and  "feelers." 

The  tactics  of  these  little  fracases  are  as  elaborate, 
as  involved,  and  as  mysterious  as  the  strategy  and 
signals  of  a  football  team.  Every  detail  is  worked 
out  and  rehearsed  for  days  and  even  weeks  in  ad- 


THE  ARMIES  AT  PLAY  421 

vance,  and  the  ingenuity  and  enthusiasm  expended 
in  planning  something  new  ''to  put  over  on  Fritz" 
is  something  incredible,  and  about  as  stimulating 
intellectually  as  anything  that  can  well  be  imagined. 
Every  last  private  must  not  only  understand  per- 
fectly the  whole  scheme  and  be  letter  perfect  in  his 
own  part,  but  often  be  ready  with  two  and  some- 
times three  alternative  courses  of  action  in  the  event 
of  any  part  of  the  scheme  miscarrying.  No  Man's 
Land  after  dark  is  no  place  for  a  **bonehead." 

Never  before  in  war  was  so  high  a  premium  placed 
upon  individual  intelligence  and  initiative,  and  on 
direct  observation  one  begins  to  discover  some  little 
basis  for  the  consoling  belief  that,  in  spite  of  the  whole- 
sale destructiveness  of  modern  warfare,  intelligence 
does  distinctly  increase  the  chances  of  survival. 

On  the  lighter  side  of  athletic  life  every  regiment 
has  its  football  team,  its  tug-of-war  team,  its  cham- 
pion sprinter  or  hurdler,  or  putter  of  the  shot,  and 
meets  and  field  days  of  all  sorts,  including  even  box- 
ing tournaments,  are  held  as  regularly,  and  far  more 
enthusiastically,  than  regimental  inspections. 

;  All  sorts  of  unexpected  faculties  and  habits  come 
in  useful  in  war-time.  The  most  distinctive  feature, 
to  a  Northerner,  of  a  Latin  town  or  village,  whether 
Mexican,  Cuban,  French,  Spanish,  or  Italian,  is  that 
it  possesses  a  plaza  and  has  the  boulevard  habit. 
Both  of  these  institutions  are  ostensibly  intended  for 


422  THE  DOCTOR  IN  WAR 

special  functions  of  their  own,  the  plaza  being  a  for- 
mal, central  square  or  park  for  the  grouping  and 
enhancement  of  public  buildings  and  official  resi- 
dences, while  the  table-covered  terraces  of  the  boule- 
vard are  a  mere  overflow  from  the  caf6s  which 
border  it. 

But  the  real  function  and  excuse  for  existence  of 
both  of  them  is  their  frank  recognition  of  the  eternal 
truth  that  the  darling  'study  of  mankind  is  man,  and 
the  superb  facilities  which  they  furnish  to  the  entire 
community,  from  the  lowest  to  the  highest,  to  enjoy 
freely  this  keenest  and  most  lasting  of  pleasures :  to 
see  and  to  be  seen,  to  talk  and  to  listen,  to  feel  one's 
self  warmly  and  actively  in  touch  with  all  the  cur- 
rents and  interests  of  one's  kind;  in  short  to  be  '4n 
the  swim,"  *'on  the  spot,"  as  our  English  cousins 
say,  "in  the  know."  Here  one  can  stroll  and  be 
looked  at  or  sit  and  pass  judgment,  can  hear  the 
freshest  gossip,  pick  up  the  most  confidential  of 
news,  and  retail  the  spiciest  of  scandals. 

So  important,  in  fact,  do  most  Latin  communities 
hold  this  side  of  life  that  they  deliberately  devote, 
not  merely  all  the  languorous  summer  evenings,  but 
from  two  to  three  hours  in  the  middle  of  the  winter 
day  in  the  cafes  to  this  form  of  intellectual  exercise 
and  development.  And  a  man's  standing  in  the  com- 
munity, even  in  so  busy  and  bustling  a  city  as  Paris, 
is  often  determined  almost  as  much  by  his  social 


THE  ARMIES  AT  PLAY  423 

gifts,  or  powers  of  eloquence  and  reasoning  in  these 
open  forums  as  by  his  financial  standing  or  his  po- 
litical or  professional  abilities. 

This  habit  and  tendency  form  a  wonderful  asset 
and  advantage  when  it  comes  to  providing  entertain- 
ment and  recreation  for  an  army  in  the  field.  In  the 
French  Army  Camps  the  formal  entertainments  and 
educational  features  are  taken  care  of  by  the  "Foyer 
des  Soldats,"  or  ''Soldiers'  Hearth,"  a  very  cheerful 
and  useful  men's  club,  but  with  a  less  extensive  and 
complete  organization  than  the  Y.M.C.A.  or  the 
Official  English  Lecture  Courses,  for  the  greater 
part  of  the  men's  recreation  is  spontaneous  and  un- 
official. Every  one  who  lives  long  among  the  French 
people  is  struck  by  the  fact  that  they  have  a  much 
greater  capacity  for  entertaining  themselves  than 
have  we  more  chilly  and  self-contained  Northern 
races.  They  are  less  self-conscious,  are  far  better  con- 
versationalists, and  have  much  easier  and  more  natu- 
ral graces  and  manners.  So  that  the  mere  society  of 
their  kind  is  to  them  a  perpetual  feast,  and  a  package 
of  hayseed  tobacco,  with  a  couple  of  "mazagrans" 
or  glasses  of  light  wine,  and  a  dozen  or  fifteen  of  their 
comrades  and  cronies,  will  provide  never-failing  enter- 
tainment and  delight  three  hundred  and  sixty-five 
nights  out  of  the  year. 

The  conversation  in  many  of  these  camp-fire  groups 
and  dug-out  debating  societies  is  excellent,  some  of 


424  THE  DOCTOR  IN  WAR 

the  most  entertaining  and  informing  that  I  have  ever 
listened  to,  even  under  the  handicap  of  an  imperfect 
apprehension  of  all  the  subtleties  of  the  eloquent  but 
elusive  French  tongue.  Every  grade  of  intelligence, 
every  type  of  interest,  every  social  viewpoint  is 
represented  in  the  rank  and  file  of  the  French  Army. 
The  shaggy  poilu,  in  faded  blue  tunic  and  ploughboy 
boots,  who  sits  on  the  cracker  box  opposite,  may  be 
a  famous  artist  with  scores  of  successes  in  the  Salon 
to  his  credit.  The  trim  young  Sergeant,  proud  of  his 
honor  stripes,  who  sits  next  to  you,  may  be  a  rising 
poet  and  darling  of  the  cafes  of  the  Quartier  Latin ; 
while  the  burly,  grizzled  Major  on  your  left  may  be 
a  lecturer  at  the  Sorbonne  or  an  eminent  authority 
on  international  law. 

Nor  is  this  a  mere  fancy  sketch.  In  one  single 
headquarters  mess  in  a  little  country  inn  in  the 
Vosges,  whose  guest  I  was,  one  academic  or  scientific 
title  after  another  was  mentioned,  until  I  asked  per- 
mission to  make  formal  count,  and  we  found  around 
the  plain  pine  table  no  less  than  five  college  pro- 
fessors, one  Academician,  a  former  Deputy  of  the 
French  Parliament,  and  a  well-known  essayist  and 
critic.  And  on  my  visits  to  the  French  Front  I  found 
myself  looking  forward  eagerly  all  day  to  the  eve- 
nings spent  over  the  coffee-cups  and  the  decanters 
with  the  officers,  whose  ready  wit  and  glancing  hu- 
mor, whose  eloquence  and  gay  delight  in  defending 


THE  ARMIES  AT  PLAY  425 

the  most  daring  and  startling  of  paradoxes,  whose 
keen  logic  and  brilliant  criticism  form  some  of  the 
happiest  memories  of  my  entire  trip. 

Even  the  rank  and  file  of  the  French  Army  are  for 
the  most  part  surprisingly  well  read  and  well  informed 
on  most  of  the  subjects  of  the  day  —  except  any  his- 
tory, or  geography  other  than  that  of  la  belle  France j 
everything  outside  of  whose  thrice  happy  borders 
is  a  wilderness  and  desolation  to  them.  And  they 
can  weave  the  most  beautiful  and  animated  and 
eloquent  evening's  conversation  out  of  the  ideas 
suggested  by  a  mere  handful  of  insignificant  facts, 
which  would  scarce  have  provided  material  for  a 
dozen  responsive  grunts  between  phlegmatic  and 
unimaginative  Anglo-Saxons. 

The  French  camps  have  excellent  official  theaters 
and  moving-picture  shows,  and  whole  companies  of 
famous  actors  and  actresses  and  vaudeville  stars  vol- 
unteer their  services  to  travel  up  and  down  the  lines 
and  bring  pleasure  and  relaxation  into  the  lives  of 
those  who  have  devoted  themselves  to  the  defense 
of  their  country. 

Similar  organizations  and  arrangements  exist  along 
both  the  English  and  the  Italian  Fronts,  and  one  of 
my  most  picturesque  memories  is  an  open-air  the- 
atrical performance  that  I  attended  in  a  beautiful 
little  bowl  among  the  hills,  just  at  the  foot  of  the 
Carso,  where  a  company  of  actresses  and  actors  from 


426  THE  DOCTOR  IN  WAR 

Milan  presented  with  spirit  and  vigor  two  charming 
little  comedies  before  almost  half  a  division  of  Italian 
soldiers,  over  four  thousand  strong.  The  huge  de- 
lighted audience  of  Bersaglieri  in  their  sweeping 
cocks'-plumes,  of  infantry  and  artillerymen  in  their 
shimmering  gray,  and  of  Alpini  in  their  green  Tyro- 
lese  hats  and  deers'  tails,  was  most  appreciative,  but 
keenly  critical  as  well.  One  music-hall  favorite  had 
omitted  one  of  the  sauciest  verses  of  her  song  out  of 
deference  to  the  dignity  of  the  Generals  of  the  Head- 
quarters' Staff  who  filled  up  the  front  rows  with  their 
stars  and  ribbons.  The  soldiers  noticed  the  omission 
at  once,  and  when  she  came  back  for  her  encore  they 
shouted  loudly,  "Sing  the  other  verse,  signorita! 
Never  mind  the  Generals;  they  won't  care,  and  the 
Censor  is  n't  here! " 

The  only  other  disturbance  of  good  order  was  when 
an  impudent  Austrian  airplane  came  zooming  over 
the  Carso  and  tried  to  get  near  enough  to  break  up 
the  show  with  bombs  instead  of  cabbages  and  eggs. 
But  a  couple  of  Italian  machines  promptly  shot  up 
and  chased  him  away  before  he  could  get  near  enough 
to  do  any  damage. 

The  reading-room,  letter- writing,  and  light  restau- 
rant accommodations  for  the  Italian  soldiers  are 
provided  by  the  wooden  halls  known  as  "Casa  del 
Soldati."  These  are  equipped  and  generously  sup- 
ported by  the  larger  Italian  cities  —  Milan,  Turin, 


THE  ARMIES  AT  PLAY  427 

Bologna,  Florence  —  and  are  gratefully  appreciated 
by  the  soldiers.  But  when  it  comes  to  entertainment 
and  amusement,  the  Italian  soldier  can  take  care  of 
himself  even  better  than  his  French  comrade.  He  is  a 
wonderfully  cheerful,  happy,  plucky,  uncomplaining 
chap,  the  best  of  good  company  to  himself  and  to 
every  one  else  about  him.  I  don't  mind  confessing 
that  I  fell  completely  in  love  with  him  in  my  month 
on  the  Isonzo  and  formed  a  very  high  opinion  of  his 
intelligence,  endurance,  and  soldierly  qualities ;  which 
I  am  proud  to  feel  has  been  more  than  justified,  after 
his  temporary  disaster  on  the  Isonzo,  by  his  splen- 
did tenacity  and  determination  on  the  Piave,  the 
Brenta,  and  Monte  Grappa. 

He  is  content  with  the  simplest  and  plainest  of 
foods  —  bread,  cheese,  meat  stew,  onions,  red  wine  — ■ 
hard  work  all  day  and  a  hard  couch  at  night,  if  he 
can  only  have  a  couple  of  hours  in  the  sunset  and 
the  twilight  to  stretch  himself  and  chat  and  joke, 
to  strum  upon  his  mandolin,  to  sing  to  its  plaintive 
strains  or  dance  to  its  lively  ones.  His  pluck  and 
cheerfulness,  when  wounded  and  suffering,  are  simply 
beyond  praise.  I  have  heard  men  shot  through  the 
chest  or  abdomen,  or  with  both  legs  shattered,  joke 
and  laugh  with  the  bearers,  as  they  were  being  lifted 
out  of  the  ambulance  to  be  carried  to  the  operating- 
table. 

No  army  on  the  Western  Front  could  show  finer 


428  THE  DOCTOR  IN  WAR 

examples  of  heroism  and  devotion.  I  saw  the  slopes 
on  the  Carso  where,  in  the  early  months  of  the  war, 
when  they  were  almost  destitute  of  heavy  artillery, 
one  volunteer  party  after  another  had  rushed  right 
up  to  the  barbed-wire  entanglements  of  the  Austrian 
intrenchments,  carrying  tubes  of  high  explosives 
which  they  hurled  into  the  wire  hy  hand  —  well  know- 
ing that  none  would  return  unwounded,  and  few 
alive  —  until  a  breach  was  cleared  through  which 
the  columns  behind  could  pour  over  their  bodies  and 
flood  the  enemy  trenches. 

No  other  army  had  so  splendid  a  record  and  dis- 
play of  patient,  tireless  work  actually  accomplished, 
of  superb  automobile  roads,  carried  to  the  very  tops 
of  the  mountains,  of  bridges  built,  tunnels  bored ;  of 
mountains  pierced  or  their  whole  tops  blown  off  by 
mines;  to  say  nothing  of  heavy  guns  dragged  up 
above  the  snow-line  or  mounted  on  giddy  peaks 
where  there  was  scarce  footing  for  a  chamois,  and 
wonderful  cable  aerial  railways  swinging  like  spiders' 
webs  from  crag  to  crag  or  from  the  brink  of  the  preci- 
pice to  the  valley  below. 

Really  they  were  such  a  busy  and  industrious  com- 
munity that  they  struck  me  as  having  less  leisure  for 
mere  entertainment  and  educational  activities  than 
almost  any  army  that  I  visited.  After  a  hard  day*s 
work  to  smoke  and  chat  and  lounge  in  the  soft  eve- 
ning air  seemed  to  be  enjoyment  enough  for  them; 


THE  ARMIES  AT  PLAY  429 

while  the  officers  were  such  courteous  and  obliging 
guides,  such  stanch  and  cordial  comrades,  such 
charming  good  company"  and  good  fellows  that  my 
eye  lights  up  and  my  heart  warms  to  this  day  at 
the  very  sight  of  an  Italian  uniform. 

In  all  the  French,  and  in  many  of  the  Italian,  camps 
there  were  excellent  cooperative  stores,  managed  by 
committees  appointed  by  the  men  themselves,  which 
supplied  tobacco,  chocolate  and  other  sweets,  soap 
and  toilet  articles,  stationery,  smaller  articles  of 
wearing  apparel,  and  the  innumerable  odds  and  ends 
required  to  supplement  army  supplies  in  a  camp. 
Buying  at  wholesale  sind  often  in  conjunction  with 
the  army  contractor,  these  stores  were  able  to  supply 
an  excellent  quality  of  goods  at  very  moderate  prices. 
Just  as  an  illustration,  on  several  different  occasions 
the  officer  who  was  acting  as  my  guide  and  escort 
would  make  some  excuse  for  going  past  the  coopera- 
tive store,  because  he  could  buy  some  particular 
brand  of  cigarette  or  toilet  article  or  pocket  cutlery 
cheaper  than  he  could  in  the  regular  shops  in  the 
towns  at  the  Base  or  even  in  Paris.  All  profits  made 
were  returned  to  the  soldiers. 


XXIV 

THE  PULSE  AND  TEMPERATURE  OF 
FRANCE 

IT  is  as  hard  to  fix  any  single  test  and  index  of  the 
health  and  resisting  power  of  a  nation  at  war  as 
of  an  individual.  The  numbers  of  a  nation  may  be 
counted,  the  weight  of  a  man  taken  on  the  scales, 
but  this  gives  mere  bulk,  not  quality.  Whether  the 
bulk  be  fat  or  muscle,  chest  or  "corporation,"  "bay 
window,"  remains  to  be  seen. 

One  can  measure  the  bulge,  or  the  lifting  power,  or 
the  punch  of  the  muscles  of  an  athlete,  or  list  the  size 
and  equipment  of  the  army  which  a  nation  can  call 
to  its  colors.  But  these  are  the  mere  cutting  edge  of 
the  ploughshare ;  how  it  will  drive  its  conquering  way 
through  the  long  stern  furrow  of  war  or  fever  depends 
upon  the  heart  and  circulation  and  vital  resources 
behind  it. 

A  nation  at  war  is  like  a  man  fighting  a  fever,  or, 
more  aptly,  like  one  who  has  had  the  valves  of  his 
heart  damaged,  so  that  its  muscle  has  to  work  much 
harder  to  pump  the  same  amount  of  blood  over  the 
body.  At  first  everything  is  excitement  and  upset 
and  block,  half  the  normal  activities  thrown  out  of 
gear.  Collapse  seems  imminent,  but  gradually  a  sort 


THE  PULSE  OF  FRANCE  431 

of  compromise  is  adjusted,  some  parts  of  the  body 
learn  to  do  with  less  blood,  others  to  utilize  more  of 
it;  "compensation,"  as  we  say  in  pompous  techni- 
cal terms,  "is  established,"  and  a  working  balance 
reached  which  may  be  maintained  for  years  and  even 
decades. 

Some  cynic  physician  philosopher  has  declared  that 
the  best  way  to  reach  a  good  old  age  is  to  acquire 
some  chronic  disease  and  then  take  good  care  of  it. 

Nations  have  even  greater,  wider  powers  of  "com- 
pensation "  and  adjustment  than  individuals  because 
their  vital  organs  and  "parts"  are  interchangeable, 
and  they  never  die.  Moreover,  paradoxic  and  even 
incredible  as  it  may  sound,  there  is  ground  for  doubt 
whether  war  is  as  utterly  abnormal  a  state  for  a 
nation  as  fever  is  for  an  individual.  Certainly  it  is  a 
process  of  which  it  has  had  an  astonishing  amount  of 
experience,  and  which,  if  it  had  not  been  well  able  to 
"carry  on,"  for  long  periods  without  vital  damage,  it 
would  never  have  survived  to  the  present  day. 

Indeed,  though  we  speak  most  confidently  and  axi- 
omatically  of  peace  being  the  usual  state  and  regular 
business  of  a  nation,  while  war  is  its  occasional  and 
exceptional  addiction  and  interlude,  yet  even  this 
belief  is  not  so  firmly  based  as  could  be  wished.  For 
instance,  careful  study  from  this  point  of  view  of  the 
last  four  hundred  and  fifty  years  of  European  history, 
from  1450  to  1900,  by  Dr.  Frederic  Adams  Woods, 


432  THE  DOCTOR  IN  WAR 

reveals  the  appalling  fact  that  in  the  first  century  of 
that  period  war  occupied  fifty-five  per  cent  of  the 
time  and  in  the  last  century  over  thirty  per  cent  I  In 
the  whole  four  hundred  and  fifty  years  there  have 
been  only  two  periods,  one  of  ten  and  the  other  of 
seventeen  years,  of  complete  and  universal  peace  all 
over  the  Continent.  So  that  while  Europe  has  un- 
questionably made  its  greatest  and  most  wonderful 
progress  during  the  last  century  of  comparative  peace, 
it  evidently  takes  a  good  deal  of  war  to  crush  or 
*'  bleed  white  "  a  nation. 

No  more  vivid  and  wonderful  demonstration  of  the 
rallying  powers  of  a  nation  under  the  strains  and 
horrors  of  war  has  ever  been  furnished  than  that  of 
heroic  France  to-day.  For  four  years  she  has  been 
the  chief  bulwark  of  democracy  and  free  civilization 
against  the  invading  flood  of  a  new  scientific  savagery 
and  feudalism,  and  yet  her  head  is  up,  her  eyes  are 
bright,  her  fire  undimmed  and  indomitable. 

The  visitor  to  France  to-day,  instead  of  being 
struck  by  the  evidences  of  change  and  exhaustion  or 
decline  of  bustle  and  activity,  is  surprised  to  find  so 
little  surface  change  in  her  streets,  her  markets,  and 
her  great  centers  of  traffic.  If  it  were  not  for  the 
strong  tinge  of  "horizon  blue"  in  the  busy  crowds, 
the  pitiful  prevalence  of  black  in  the  costumes  of  the 
women,  and  the  dim  lighting  of  the  streets  at  night, 
one  would  have  to  shake  one's  self  and  recall  the 


THE  PULSE  OF  FRANCE  433 

historic  facts  to  realize  that  one  is  really  in  a  country 
which  is  desperately  at  war. 

Part  of  this  is  due  to  the  heroic  endurance  and  lofty 
pride  of  the  French  nation,  particularly  of  the  women. 
But  part  to  certain  new  and  curious  changes  in  the 
character  of  modern  war,  which  even  help  to  compen- 
sate somewhat  for  its  abominations  in  other  respects. 

One  of  these  is  the  strange  fixity  or  "ossification" 
of  the  fighting-line,  due  to  the  trench  system  of  war- 
fare, so  that  railroad  trains  run  right  up  to  and  into 
the  zone  of  fire,  almost  up  to  the  third-line  trench 
every  few  miles,  comparatively  speaking,  all  along 
the  Front.  This  makes  "the  war"  quite  accessible 
and  convenient,  so  that  soldiers  from  all  over  the 
southern  and  eastern  parts  of  France  can  reach  their 
billets  on  the  Front  within  a  day's  ride  or  even  a  few 
hours  from  home,  and  can  come  back  again  on  peri- 
ods of  leave  or  permission  every  three  to  six  months. 

This  may  look  like  a  trivial  thing  in  itself,  but 
psychologically  it  helps  greatly  to  reassure  and  to 
take  off  some  of  the  worst  edge  of  the  dread  and 
anxiety  of  wives  and  families.  Instead  of  feeling,  as 
in  former  wars,  that  their  sons  and  husbands  are 
going  away  hundreds  of  miles,  almost  under  sentence 
of  death,  with  no  prospect  of  ever  seeing  them  again 
until  the  war  is  over  or  they  are  sent  back  disabled 
for  life,  the  families  of  the  soldiers  can  at  least  buoy 
themselves  up  with  the  hope  of  seeing  them  back 


434  THE  DOCTOR  IN  WAR 

again  on  permission  safe  and  sound  within  three 
months. 

And  as  with  all  the  deadliness  and  fierce  engines 
of  destruction  of  modern  war  not  more  than  five  per 
cent  of  the  combatants  are  either  killed  or  seriously- 
wounded  or  disabled  by  disease  within  a  year,  this 
hope  of  safe  return  is  fulfilled  in  the  vast  majority  of 
cases  a  number  of  times  before  they  are  even  suf- 
ficiently severely  wounded  to  be  invalided  home. 
This  much  more  frequent  opportunity  of  visits  home 
from  dear  ones  in  the  trenches,  while,  alas,  it  can 
do  little  to  lighten  the  terrible  blow  when  it  does 
fall  upon  the  ^we  per  cent,  does  much  to  relieve  the 
tension  of  agonized  dread  and  brooding  anxiety  of 
year-long  periods  of  absence  in  the  ninety-five  per 
cent  where  no  disaster  occurs. 

At  all  events,  it  does  visibly  and  mercifully  take 
off  some  of  the  agonized  tension  of  grief  and  forebod- 
ing dread  from  the  departure  of  a  troop  train,  or  of 
the  farewell  of  a  soldier  to  his  family  at  the  gates  of  a 
great  railway  station.  He  has  come  back  before  safe 
and  well,  why  not  again? 

Incidentally,  also,  this  constant  and  comparatively 
frequent  interchange  and  communication  between 
the  Front  and  the  home  town  helps  to  keep  the 
appearance  of  the  streets,  particularly  of  the  larger 
towns  and  main  railroad  centers,  unexpectedly  nat- 
ural, by  taking  off  the  sense  of  a  scarcity  of  young 


THE  PULSE  OF  FRANCE  435 

men  in  the  crowd.  Indeed,  this,  in  addition  to  the 
fact  that  only  a  certain  percentage  of  the  troops  is 
actually  at  or  near  the  Front,  the  remainder  being 
held  in  reserve  in  training-camps  scattered  all  through 
the  country,  and  incessantly  transferred  backward 
and  forward  from  active  to  reserve  duty,  makes  an 
almost  constant  flow  and  thronging  of  men  in  uni- 
form through  all  but  the  smaller  towns  and  country 
villages,  and  even  in  a  great  many  of  them.  So  that 
there  is  much  more  going  on  in  the  way  of  travel, 
trade,  business,  and  even  amusement  and  society  of 
a  sort,  over  all  the  central  and  eastern  half  of  France 
than  one  would  have  expected  from  conditions  in 
previous  wars. 

A  second  peculiarity  of  modern  war,  which  has 
helped  France  to  adjust  herself  and  maintain  a  work- 
ing balance  even  under  the  terrible  strain  which  she 
has  suffered,  is  that  it  is  so  emphatically  and  over- 
whelmingly a  war  of  machinery  and  big  guns.  Its 
motto  is  a  paraphrase  of  Napoleon's  "Audacity," 
''Ammunition,  and  again  ammunition,  and  always 
ammunition!"  or  ** Shells  to  save  life,"  in  Lloyd 
George's  paradoxic  phrase!  For  the  army  that  has 
most  guns  and  ammunition  loses  fewest  soldiers  in 
an  offensive. 

A  war  of  munitions  and  railroads,  of  telephone  and 
telegraph  and  electrical  equipment  of  every  imagin- 
able sort,  of  huge  howitzers  mounted  like  observatory 


436  THE  DOCTOR  IN  WAR 

telescopes,  moved  by  clockwork  and  aimed  with  sur- 
veyor's transit,  of  airplanes  and  motor  lorries  and 
motor  ambulances  by  the  hundred  thousand.  This 
enormous  and  incessant  demand  has  stimulated  man- 
ufacturing and  production  of  all  sorts  so  tremen- 
dously, new  factories  springing  up  like  mushrooms 
everywhere  to  meet  it,  that  the  whole  civilian  popu- 
lation at  home,  the  women  and  children  of  the  sol- 
diers, and  the  men  too  old  or  physically  unfit  for 
military  service,  instead  of  being  thrown  out  of  work 
and  left  to  starve,  have  had  abundant  employment 
at  double  and  even  treble  the  wages  they  had  ever 
dreamed  of  before. 

So  great  has  been  the  rise  in  wages,  so  keen  the 
demand  for  labor,  that  many  a  soldier's  wife  or 
daughter  is  actually  making  more  money  at  home  in 
the  war  factory  than  the  head  of  the  family  was  able 
to  earn  in  time  of  peace.  Wages  of  all  sorts  on  an 
average  have  doubled,  and  in  not  a  few  fields  of  in- 
dustry trebled,  since  the  outbreak  of  the  war.  And 
it  is  one  of  the  axioms  of  military  experts  that  a  na- 
tion is  physically  able  to  put  no  more  than  one  tenth 
of  its  total  population  in  the  field  for  active  service, 
or  one  half  of  its  men  of  military  age  which  means 
about  one  third  of  all  males  of  working  ages.  This 
means  that  most  of  the  other  two  thirds  and  all  the 
women  of  the  community  have  been  earning  higher 
wages  than  they  ever  did  in  their  lives  before. 


THE  PULSE  OF  FRANCE  437 

Wages  have  actually  kept  pace  with  the  higher 
cost  of  food,  and  as  many  families  have  now  two  and 
three  wage-earners  in  the  place  of  one,  the  net  result 
has  been,  in  the  almost  unanimous  opinion  of  those 
interested  and  expert  in  labor  conditions  in  France, 
that  the  great  mass  of  her  people  are  better  fed,  bet- 
ter clothed,  and  are  working  shorter  hours  and  under 
more  healthful  conditions  than  they  were  before  the 
war. 

And  this  was  the  distinct  impression,  for  whatever 
it  may  be  worth,  which  I  gained  from  my  own  per- 
sonal observation.  I  spent  nearly  six  months  in 
France  last  year,  from  spring  till  late  autumn  of 
19 1 7,  making  numerous  journeys  both  to  and  from 
the  Front  and  through  the  interior,  covering  some 
thirty  or  forty  different  regions  and  towns,  from 
country  districts  up  to  great  cities,  and  found  sur- 
prisingly little  sign  of  unemployment,  of  destitution, 
or  of  visible  underfeeding  or  food  scarcity. 

I  was  particularly  careful  to  visit  the  industrial 
sections  of  the  cities  and  towns,  the  slums  if  any,  and 
the  poorer  and  outlying  streets  of  the  country  towns 
and  villages,  to  watch  the  crowds  at  the  factory  gates, 
on  the  streets,  in  the  parks  in  the  evenings  and  on 
holidays,  and  especially  to  keep  a  keen  eye  upon 
that  best  and  most  graphic  index  of  the  vital  condi- 
tion of  a  community,  the  faces  of  the  children. 

Much  to  my  relief  and  gratification,  after  the  pessi- 


438  THE  DOCTOR  IN  WAR 

mistic  and  discouraging  reports  which  I  had  heard 
before  I  visited  France,  I  found  the  overwhelming 
majority  of  the  quaintly  charming  and  intelligent 
little  future  citizens  of  the  Republic  playing  hard  and 
happily,  with  bright  eyes,  fresh  color,  and  sturdy, 
bare,  brown  legs.  They  scurried  eagerly  about,  shout- 
ing at  the  tops  of  their  voices,  and  making  wonderful 
gesture-play  as  merrily  as  if  they  had  n't  a  care  in 
the  world,  and  were  as  well  nourished  and  vigorous, 
as  free  from  visible  defect  or  disease,  as  the  groups 
which  can  be  seen  on  our  own  streets. 

I  was  told  by  my  colleagues,  both  French  and 
American,  who  were  engaged  in  work  among  the 
children  and  in  children's  hospitals,  that  the  high 
value  placed  by  the  war  on  children  and  child  life, 
had  so  stimulated  the  activities  of  the  many  public- 
spirited  organizations  for  child  welfare,  both  French 
and  Allied,  such  as  the  English  Red  Cross  and 
many  other  equally  devoted  but  smaller  organiza- 
tions, that  the  actual  infant  mortality-rate  or  death- 
rate  among  children  under  one  year  of  age,  instead  of 
increasing,  had  been  brought  down  in  France  to  one 
of  the  lowest  levels  in  her  history! 

Incidentally,  a  like  unexpected  and  gratifying  re- 
sult has  been  brought  about  in  many  districts  in 
Belgium  by  the  devoted  efforts  of  Belgian  philan- 
thropists and  physicians  backed  by  our  American 
Belgian  Relief  Commission.  And,  of  course,  Germany, 


THE  PULSE  OF  FRANCE  439 

who  did  not  put  one  little  finger  to  the  work,  is  char- 
acteristically claiming  the  entire  result  as  one  of  the 
visible  blessings  of  Prussian  rule  and  the  sway  of 
Kultur, 

To  put  it  roughly,  a  considerable  share  of  the  huge 
sum  voted  by  the  French  Government  for  war  ex- 
penses has  gone  directly  back  into  the  pockets  and 
the  lives  of  the  working-class  majority  of  her  popula- 
tion in  the  form  of  high  wages,  and  while  this  will 
have  to  be  paid  for  some  day,  yet  for  the  present  it 
greatly  helps  to  redress  the  balance  of  industry  and 
economic  prosperity  so  rudely  shaken  by  war. 

Part  of  it  is  an  actual  drain  upon  the  total  reserves 
of  the  country  in  the  sense  of  a  new  draft  upon  the 
strength  and  vital  resources  of  its  women,  who  have 
so  nobly  and  splendidly  risen  to  and  met  the  emer- 
gency. But  not  all  of  it,  by  any  means,  because  the 
thing  which  has  made  it  possible  has  been  the  intro- 
duction of  the  most  modern  labor-saving  machinery 
on  a  tremendous  scale,  as  well  as  modem  efficiency 
methods  of  operation. 

The  motor-power  for  this  machinery  is  being 
largely  and  increasingly  drawn  from  the  hitherto 
unutilized  natural  water-power  of  the  country.  A 
most  interesting  and  striking  shift  of  the  great  manu- 
facturing industries  of  France  has  been  made  from 
the  northeastern  regions,  where  the  coal  is,  down  to 
the  plains  and  valleys  of  the  south  and  southeast,  near 


440  THE  DOCTOR  IN  WAR 

the  mountains  where  the  water-power  is.  Which  also 
has  the  advantage  of  helping  to  offset  the  German 
occupation  of  some  of  the  richest  coal  mines  and  of 
placing  the  industries  and  their  swarms  of  workers 
at  a  safer  distance  from  bomb-dropping  raids  and 
other  hostile  interference.  France  has  not  lost  for  a 
moment  either  her  splendid  courage  or  her  wonderful 
economic  shrewdness  and  foresight  in  this  terrible 
war.  This  utilization  of  her  water-power  will  be  a 
permanent  addition  to  her  national  assets  after  the 
war.  And  the  same  is  true  in  even  greater  measure 
in  the  case  of  Italy. 

It  is  not  too  much  to  say  that  most  of  this  superb 
contribution  of  war  work  by  the  women  of  France 
has  been  made  by  the  aid  of  labor-saving  machinery, 
under  such  greatly  improved  industrial  working  con- 
ditions, with  shorter  hours  and  higher  wages,  that 
it  has  been  no  greater  drain  upon  their  resources 
and  their  health  than  the  household  or  small  shop 
or  farm  occupations,  which  they  followed  before  the 
war.  Indeed,  it  has  actually  been  found,  in  a  num- 
ber of  munitions  works  studied,  in  both  France  and 
England,  that  the  women  were  able  to  feed  them- 
selves so  much  better  on  high  wages,  to  give  them- 
selves so  much  more  regular  rest,  and  to  afford  health- 
ful recreation  and  amusements  and  broader  interests 
of  life,  that  their  health,  instead  of  deteriorating, 
has  actually  improved  under  the  work.     In  most 


THE  PULSE  OF  FRANCE  441 

Government-controlled  plants  they  are  carefully 
supervised  and  guided  by  women  physicians  and 
other  welfare  workers,  so  that  they  know  how  to 
protect  themselves  and  to  take  care  of  their  health 
better  than  ever  before. 

As  for  the  much-talked-of  shortages  of  food  and 
even  "famines,"  these  actually  for  the  most  part  are 
confined  to  certain  special  articles  of  food,  such  as 
sugar,  butter,  milk,  white  flour,  pork,  etc.  Many  of 
these,  even,  are  only  temporary  and  local  in  nature, 
and  there  are  substitutes  to  be  had  except  in  the  case 
of  sugar.  Taking  it  by  and  large  —  again  speaking 
from  the  perhaps  limited  point  of  view  of  my  own 
experience  —  the  only  serious  obstacle  to  procuring 
an  adequate  supply  of  nourishing  food  in  most  parts 
of  France  that  I  visited  was  the  price.  And  even  that 
barrier  became  less  formidable  as  one  went  down  into 
the  smaller  towns  and  country  districts. 

There  was  no  white  bread,  but  plenty  of  brown 
war  bread;  in  fact,  less  restriction  was  placed  upon 
the  use  of  bread  in  the  restaurants  and  cafes,  and  so 
far  as  one  could  judge  in  private  houses,  than  in 
England.  There  was  barely  enough  sugar  for  the 
coffee,  but  plenty  of  fresh  fruit  and  vegetables,  and  a 
limited  but  adequate  supply  of  fresh  meat  and  ham. 
Prices  in  Paris  and  the  other  great  cities  were  high, 
but  no  higher  on  an  average  than  in  New  York 
or  Boston,  and  the  main  difficulty  was  skirmishing 


442  THE  DOCTOR  IN  WAR 

about  perpetually  and  exercising  one's  Ingenuity 
over  the  bills  of  fare  to  find  substitutes  that  were 
*' just  as  good,"  on  the  two  meatless  days  in  the  week 
and  the  two  on  which  desserts,  puddings,  cakes,  etc., 
containing  much  sugar  could  not  be  served. 

To  take  the  rough  test  of  restaurant  prices  all 
through  the  summer  and  up  to  the  last  week  in  Octo- 
ber, 1917,  when  I  left  France,  one  could  get  in  the 
medium-sized  and  smaller  towns  and,  what  furnishes 
a  good  average  sample,  in  the  dining-cars  on  the  rail- 
roads, a  good  satisfying  meal  —  soup  or  macaroni, 
fish  or  entr6e,  meat,  potatoes,  salad,  cheese,  and  fruit, 
for  from  65  cents  to  $1.00.  Comfortable  accommo- 
dations and  excellent  meals  could  be  got  In  country- 
town  hotels,  especially  in  the  South  and  West  or 
toward  the  Swiss  border  for  from  $1.75  to  $2.50  a 
day.  In  the  villages  and  country  districts  there  was 
a  good  supply  of  food,  though  somewhat  coarse  and 
monotonous  according  to  our  American  standards. 
Although  there  had  been  a  distinct  falling-off  in  the 
size  of  the  principal  crops,  yet  the  smaller  crops 
were  sold  at  much  higher  prices  and  the  farmers 
felt  comparatively  prosperous.  Besides,  it  must 
be  frankly  admitted  that  no  peasant  or  farmer 
anywhere  In  any  country  Is  going  to  run  himself 
dangerously  short  of  the  food  which  he  has  raised 
himself  in  order  to  supply  city  people. 

The  wheat  crop  of  France,  for  instance,  has  fallen 


THE  PULSE  OF  FRANCE  443 

off  more  than  a  third  in  three  years,  but  the  wages  of 
the  great  mass  of  working-people  have  been  so  good 
that  so  long  as  a  reasonable  supply  from  abroad  was 
procurable,  they  have  been  able  to  feed  themselves 
well.  The  only  fear  was  lest  this  supply  should  be 
cut  down  by  the  urgent  need  of  ships  for  transport- 
ing our  American  Army  to  France,  but  our  splendid 
shipbuilding  programmes  have  relieved  that  diffi- 
culty already. 


XXV 

MOUNTAINS  AND  MEDICINE:  ITALY'S  WAR 

ON  DISEASE 

ROME  was  almost  as  famous  for  her  aqueducts, 
her  baths,  and  her  sewers  as  for  her  legions  and 
her  laws.  So  when  her  descendants  and  representa- 
tives of  to-day  malce  war,  they  proceed,  on  ancestral 
grounds,  to  attack  its  sanitary  and  surgical  problems 
as  thoroughly,  as  patiently,  and  as  effectively  as  they 
attack  its  engineering  and  its  military  ones.  For  the 
offensive  of  191 7  toward  Trieste,  which  I  saw,  they 
had  in  readiness  within  twenty  miles  of  the  Front 
not  only  hundreds  of  thousands  of  men,  thousands 
of  guns,  and  millions  of  shells,  but  six  hundred  hos- 
pitals with  one  hundred  thousand  beds,  and  doctors 
and  nurses  and  ambulances  by  the  thousand. 

The  ''theater  of  war "  is  no  mere  figure  of  speech  in 
the  Italian  campaign,  for  the  whole  drama  is  set  in  a 
huge  natural  amphitheater  walled  in  by  the  semi- 
circular sweep  of  mountains,  with  dusty  blue  mists 
for  drop  curtains,  lifted  from  time  to  time  to  show 
battle-fields  literally  hung  up  in  the  air,  draped  upon 
the  shoulders  of  the  mountains  for  a  world  to  see. 

On  a  clear  day  you  can  see  the  shells  bursting 
on  the  ridge-crests  around  Monte  Nero,  silhouetted 


MOUNTAINS  AND  MEDICINE     445 

against  the  violet  sky,  twenty  miles  away.  And  the 
mountains  dominate  the  whole  movement. 

It  is  a  war  of  mountains,  for  mountains,  between 
mountains  —  I  had  almost  said  by  mountains;  for  no 
sooner  is  one  mountain  captured  than  it  is  organized 
and  armed  into  a  fortress  for  an  attack  upon  the  next 
mountain  facing  it  across  the  deep  valley.  Every- 
thing has  to  learn  to  climb  and  half-dig  itself  in, 
half-hang  on  by  its  toe-nails  and  eyelids  on  some 
narrow  shelf  on  the  mountain-side :  not  merely  men 
and  guns,  horses,  mules,  Field-Hospitals,  Dressing- 
Stations,  motor-dynamos,  but  huge  water-casks 
and  boats,  great  whale  boats  and  barges,  to  be  used 
for  the  pontoon  bridges  across  the  fierce  little  river 
at  the  bottom  of  the  gorge  below  the  next  mountain. 

I  have  seen  long  black  bateaux,  capable  of  holding 
forty  men,  hauled  up  the  ''safe  and  sane"  side  of  the 
mountain,  where  there  are  fine  roads,  on  huge  motor 
lorries  or  tractors,  to  be  lowered  by  cable  down  the 
"unhealthy"  side  over  rocks,  cliffs,  and  trees  —  for 
roads  don't  grow  well  under  shell-fire  —  in  the  dark- 
est and  quietest  hours  of  the  night  —  if  there  are  any 
for  the  star-shells  and  Verey  lights. 

Most  of  the  plagues  of  the  soldier  are  his  old  familiar 
home  diseases  in  more  vicious  form.  Typhoid,  pneu- 
monia, tuberculosis,  dysentery,  heart  disease,  kidney 
disease,  these  are  the  maladies  which  account  for  the 


446  THE  DOCTOR  IN  WAR 

vast  majority  of  deaths  in  camp  and  barrack,  just  as 
in  peaceful  civil  life. 

But  sometimes  the  fierce  earthquake  of  war  shakes 
and  hurls  us  back  to  the  primitive,  in  both  morals 
and  maladies,  and  raises  unexpected  ghosts  of  strange 
and  half-forgotten  ancient  diseases  to  vex  us  again. 
Some,  fortunately,  are  too  dead  to  rise  again  in  any 
earthquake  resurrection,  however  rending  —  "Black 
Death,"  smallpox,  the  sweating  sickness,  these,  we 
believe,  can  never  raise  their  heads  again  in  any 
civilized  and  sanitary  community;  though  we  boast 
with  our  fingers  crossed,  and  our  knuckles  rapping 
on  ligno-cellulose  substance. 

But  a  few  of  the  historic  plagues  are  not  buried  so 
deeply  nor  so  dead,  and  two  of  them  have  come  to 
life  again  in  this  war,  typhus  and  cholera,  both  from 
the  regions  of  the  Unwashed  East;  both  brought  in 
by  Austrian  prisoners,  typhus  into  Serbia,  cholera 
into  Italy. 

The  typhus  epidemic  ran  like  wildfire  through  the 
war-ravaged  and  half-famished  Serbia,  until  it  was 
tackled,  and  not  merely  checked  but  completely 
stamped  out,  by  the  splendid  and  masterly  work  of 
an  Anglo-American  Commission. 

Italy's  cholera  epidemic  faced  her  suddenly  in  the 
first  year  of  the  war,  in  most  menacing  proportions. 
The  disease  came  in  gradually  and  insidiously  in  the 
form  of  scattered  cholera-carriers  among  the  first 


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MOUNTAINS  AND  MEDICINE     447 

thousands  of  Austrian  prisoners.  There  were  no 
open  cases,  nothing,  in  fact,  to  arouse  any  suspicion 
whatever  until  these  prisoner  carriers  had  been  scat- 
tered out  through  a  number  of  prison  camps  and 
had  infected  the  water-supply  of  some  of  the  Italian 
troops. 

Then,  with  the  approach  of  the  hot  weather,  like 
a  forest  fire  that  had  run  underground,  the  disease 
burst  out  in  full  vigor,  in  a  dozen  different  centers  at 
once,  and  within  a  few  weeks  the  sanitarians  had 
seven  or  eight  thousand  cases  on  their  hands. 

But  not  a  moment  was  lost  in  attacking  the  out- 
break. The  Sanita  of  the  Italian  Army  fell  upon  it 
at  once,  horse,  foot,  and  dragoons,  in  a  most  work- 
manlike fashion.  All  known  cases  were  isolated  in 
comfortable  hospital  camps,  given  the  best  of  treat- 
ment and  care,  and  their  discharges  rigidly  sterilized 
so  as  to  prevent  any  further  spread  of  the  disease 
from  them. 

How  intelligent  and  effective  was  the  treatment 
given  them  may  be  judged  by  the  fact  that,  while 
the  ordinary  death-rate  from  cholera  is  from  thirty 
to  fifty  per  cent,  the  total  losses  among  these  cases 
were  barely  twenty  per  cent,  including  a  considerable 
number  of  the  earliest  cases,  who  were  almost  at 
death's  door  before  the  disease  was  properly  recog- 
nized. In  fact,  the  death-rate  in  the  first  few  weeks 
of  the  disease  was  something  like  forty  per  cent, 


448  THE  DOCTOR  IN  WAR 

showing  that  it  was  no  mild  or  trifling  type  of  the 
dread  infection. 

Then  all  who  had  come  in  contact  or  were  sus- 
pected of  having  come  in  contact  with  the  cases, 
or  had  drunk  of  presumably  infected  water,  were 
given  the  cholera  vaccine,  which,  though  not  so  cer- 
tain or  so  perfect  as  the  smallpox  and  the  typhoid 
vaccine,  was  found  to  give  a  very  helpful  degree  of 
protection.  All  water-supplies  for  the  troops  and 
prisoners  were,  of  course,  chlorinated  at  once,  so  as 
to  short-circuit  the  spread  of  the  infection  along  that 
wire. 

Then  the  disinfection  brigade  got  busy  with  their 
big  tank  pumps  on  wheels,  like  old-fashioned  fire 
engines,  and  hosed  and  sluiced  down  every  infected 
building  or  hut  or  hospital  with  floods  of  perman- 
ganate and  bichloride  solution.  In  some  cases  they 
even  went  into  the  trenches,  and  flushed  and  flooded 
and  sprayed  the  walls  and  the  floor-bottoms,  and  the 
dug-outs  and  underground  shelters.  The  germs  must 
have  thought  it  was  Deluge  No.  2,  only  a  bichloride 
Flood  this  time. 

Within  a  few  weeks  the  new  cases  began  to  tail  off 
rapidly,  and  although  the  cholera  still  smouldered 
along  slowly,  with  a  few  scattered  cases  here  and 
there  until  the  approach  of  the  cool  weather  sent  it 
into  winter  quarters  after  its  usual  fashion,  yet  its 
back  had  been  broken  by  the  first  rush,  so  that  it 


MOUNTAINS  AND  MEDICINE     449 

was  held  down  to  a  total  of  barely  ten  thousand 
cases  with  two  thousand  deaths,  only  a  couple  of 
thousand  beyond  the  first  month's  outburst. 

Everybody,  of  course,  was  on  the  qui  vive  for  a  new 
crop  of  the  disease  in  the  spring,  but  so  thoroughly 
had  the  work  of  stamping  out  been  done,  that  out  of 
over  a  million  soldiers  and  a  hundred  thousand  pris- 
oners on  the  Isonzo  Front,  only  about  twelve  hun- 
dred cases  developed  with  some  two  hundred  deaths, 
and  when  I  was  there  in  August  in  the  next  cholera 
season,  there  had  scarcely  been  a  single  case. 

But  the  Sanita  takes  no  risks  with  its  future  prison- 
ers; they  are  made  to  walk  the  bacteriological  plank 
in  the  most  thorough-going  fashion.  Just  as  soon  as 
they  are  brought  down  from  the  mountains  into  the 
first-line  prison  camps,  which  are  well  isolated  from 
the  barracks  of  the  troops,  they  are  first  stripped 
and  examined  for  vaccination  scars  against  smallpox, 
and  if  they  cannot  show  a  clear-marked,  recent  scar, 
they  are  promptly  vaccinated.  As  soon  as  they  have 
recovered  from  this,  they  are  given  an  injection  of 
the  anti-typhoid  vaccine,  then  they  and  their  cloth- 
ing are  thoroughly  "unloused,"  in  steam  sterilizers 
and  hot  baths. 

Finally,  before  they  are  allowed  to  go  on  to  the  per- 
manent camps  or  working-gangs  in  the  interior  of  the 
country,  the  feces  of  every  one  of  them  are  bacterio- 
logically  examined  for  the  cholera  germ,  to  be  sure 


450  THE  DOCTOR  IN  WAR 

that  there  are  no  carriers  among  them.  This  sounds 
rather  tempestuous  for  the  poor  prisoners,  but  as 
they  are  well  fed,  comfortably  housed,  kindly  treated, 
and  delighted  to  get  out  of  the  trenches,  they  bear 
it  nobly  without  murmur,  apparently  in  the  philo- 
sophic hope  that  some  future  good  may  come  out  of 
all  this  tribulation. 

Nor  are  they  disappointed,  for  the  net  result  of 
what  twenty  years  ago  would  have  been  viewed  as 
mere  doctors'  fussiness  and  tomfoolery,  is  that  in  all 
her  prison  camps,  in  over  two  and  a  half  years  of 
war,  Italy  has  scarcely  had  a  single  serious  epidemic 
or  outbreak  of  troublesome  disease ! 

I  visited  several  of  these  disinfection  prison  camps, 
and  found  them  on  well-drained  ground,  usually 
near  the  banks  of  some  stream  and  surrounded  with 
a  high  double  fence  of  barbed  wire.  Along  one  side 
were  rows  of  plain,  comfortable,  rough  board  bunk- 
houses,  a  long  dining-shed  and  mess  kitchen,  in  one 
of  which  I  saw  the  prisoners  at  dinner,  with  appar- 
ently exactly  the  same  food  as  the  Italian  soldiers 
were  receiving  in  their  messes.  There  was  a  good 
supply  of  pure  drinking-water,  and  in  front  of  the 
bunk-houses  were  one  or  more  great  cement  troughs, 
almost  tanks  in  size,  forty  or  fifty  feet  long,  eight  feet 
wide  and  four  deep,  with  a  continuous  flow  of  water 
through  them  from  a  standpipe.  They  had  ledges 
wide  enough  to  hold  soap,  towels,  and  small  articles 


MOUNTAINS  AND  MEDICINE     451 

of  clothing,  and  were  used  by  the  prisoners  both  for 
their  own  ablutions  and  for  washing  their  clothing. 

On  the  other  side  of  the  ground  was  a  small  hospital, 
plain  and  rough,  but  clean  and  well  equipped,  with 
good  bedding  and  blankets,  and  at  the  end  near  the 
entrance  were  the  quarters  of  the  commandant  and 
of  the  guards.  A  wide  strip  of  the  ground  along  the 
hospital  side  of  the  camp  was  turned  into  garden, 
and  planted,  not  merely  with  vegetables,  but  also 
with  flowers,  both  to  afford  occupation  for  the  pris- 
oners and  to  supply  them  with  fresh  vegetables. 

There  were  good  latrines  of  the  cement  tank  type, 
and  ever3^hing  was  spotlessly  clean,  not  an  offensive 
odor  or  a  sign  of  garbage  or  refuse,  or  a  fly  anywhere. 

The  ''  unlousing  '*  equipment  is  a  most  effective  and 
interesting  one.  A  long,  shed-like,  wooden  building 
divided  into  a  roomy  undressing-room  at  one  end, 
a  dressing-room  at  the  other,  and  between  the  two 
on  the  one  side  a  huge  steam  sterilizer  and  on  the 
other  a  large  bathroom  with  hot- water  douches  pour- 
ing from  overhead  pipes.  The  prisoners  undress  in 
the  first  room,  their  clothing  is  put  into  wide-meshed 
net  bags  and  promptly  passed  into  the  steam  steril- 
izer, and  they  themselves  march  into  the  bathroom. 
Here  they  stand  under  the  douches,  and  lather  them- 
selves thoroughly  with  soap,  while  an  orderly  at  one 
end  of  the  room  stands  with  a  flexible  hose,  which 
he  turns  on  their  chests  and  backs  as  they  rotate 


452  THE  DOCTOR  IN  WAR 

slowly  before  him  for  inspection,  to  make  good  any 
oversights  in  their  toilet. 

Then  they  go  on  into  the  dressing-room,  where 
they  meet  their  clothes  which  have  already  arrived 
from  the  steam  sterilizer,  the  two  are  reunited  and 
out  they  go  clean  and  cootie-free,  safe  for  a  fort- 
night at  least.  The  steam  is  superheated  to  such  a 
temperature  that  all  that  is  necessary  is  to  open  the 
bundle  of  clothing,  give  each  garment  a  shake  and 
it  is  dry  in  a  second. 

The  heads  of  the  soldiers  are  gone  over  in  most 
domestic  fashion  with  the  familiar  fine-tooth  comb 
of  unblest  childhood  memory,  and  then  they  are 
given  boxes  of  fragrant  or  rather  loud-smelling  salve 
containing  insecticides  to  rub  into  their  armpits. 

A  similar  equipment  is  a  regular  institution  In 
every  camp  of  a  battalion  or  more  all  along  the 
whole  Western  Front  and  has  enormously  reduced 
the  Fifth  Plague  of  Egypt. 

Incidentally,  it  may  be  noted  that  this  is  in  some- 
what striking  contrast  with  Germany's  method  of 
handling  outbreaks  of  typhus  in  her  prison  camps. 
This  has  the  merit  of  being  of  a  charming  simplicity 
and  inexpensiveness,  and  consists  in  promptly  with- 
drawing the  prison  doctors  and  hospital  attendants 
and  all  other  German  officials  from  the  camp,  post- 
ing a  double  guard  round  the  barbed-wire  stockade, 
throwing  over  supplies  of  food  each  day,  and  letting 


MOUNTAINS  AND  MEDICINE     453 

the  disease  run  its  course  and  bum  itself  out.  It  saves 
disinfectants  and  all  other  expense,  and  has  in  addi- 
tion the  advantage,  as  one  of  the  prison  commandants 
explained  with  engaging  frankness,  of  leaving  ''fewer 
of  these  verflilchte  Engldnder  to  trouble  us." 

My  visit  to  the  Italian  Front  was  one  of  the  most 
interesting  and  delightful  features  of  my  entire  trip. 
It  began  with  the  inspection  of  some  eight  or  nine  of 
the  great  Base  Hospitals  in  Rome,  which  were  su- 
perbly equipped  and  managed.  Two  or  three  were 
ordinary  military  surgical  hospitals  for  the  wounded, 
but  as  Rome  is  a  considerable  distance  back  from 
the  firing-line,  the  major  part  of  its  hospitals  were 
utilized  for  medical  diseases  and  chronic  conditions 
and  for  reconstruction  purposes,  while  the  wounded 
were  mainly  sent  to  the  great  hospitals  nearer 
the  Front  in  Milan,  Turin,  Padua,  Bologna,  and 
Florence. 

One  of  the  most  interesting  was  an  establishment 
for  tuberculous  soldiers  in  the  Villa  Celio,  on  a  hill- 
top, with  a  superb  view  off  over  the  Campagna  and 
the  distant  hills.  Here  were  received  the  men  who 
had  broken  down,  presumably  from  tuberculosis, 
or  who  had  failed  to  pass  the  Draft  Board  for  the 
same  cause.  They  were  given  a  thorough  and  careful 
X-ray  examination,  the  Pirquet  skin  test  for  tuber- 
culosis, their  sputum  was  examined  under  the  micro- 
scope, and  they  were  held  under  observation  for 


454  THE  DOCTOR  IN  WAR 

from  one  to  three  weeks,  meanwhile  sleeping  on  great 
galleries  in  the  open  air,  liberally  and  abundantly 
fed,  and  given  the  best  and  most  skilled  of  medical 
treatment. 

Then  those  who  were  found  not  to  be  tuberculous, 
who  were  quite  a  considerable  moiety  of  the  number, 
were  sent  back  to  their  regiments  or  to  such  work 
as  they  were  fitted  for  behind  the  lines.  Those  that 
were  in  an  early  stage  of  the  disease  were  sent  to 
sanatoria  which  the  Italian  Government  had  built 
since  the  war,  up  in  the  mountains,  while  those  for 
whom  the  outlook  was  less  hopeful,  or  whose  disease 
was  complicated  by  wounds  or  other  morbid  con- 
ditions, were  sent  to  hospitals  arranged  for  their  re^ 
ception,  each  man  being  sent  to  the  establishment 
nearest  to  his  home  and  family. 

The  system  is  admirably  worked  out  with  the  assist- 
ance of  the  Italian  Red  Cross.  Soldiers  found  tuber- 
culous are  given  pensions  for  three  years  and  support 
for  their  families  meanwhile.  The  suspects  among 
the  repatriated  prisoners  of  war  are  sent  on  in  the 
same  train  to  the  seaside  sanatorium  at  Nervi,  which 
has  accommodations  for  1200.  The  suspects  from  the 
Army  are  sent  to  the  sanatorium  near  Florence.  Both 
are  new  and  well-equipped  sanatoria,  beautifully 
located.  The  Red  Cross  has  two  trains  for  the  tuber- 
culous, four  climatic  sanatoria  with  a  total  of  900 
beds,    and    three    institutions   for   the   moderately 


MOUNTAINS  AND  MEDICINE     455 

severe  cases,  with  640  beds.  The  Army  has  seven 
regional  sanatoria,  with  a  total  of  3808  beds,  eleven 
institutions  for  the  advanced  cases,  besides  the  Nervi 
and  Florence  sanatoria,  and  centers  in  each  army 
corps  for  prolonged  observation  and  diagnosis  by  the 
most  approved  methods.  Some  corps  have  more  than 
one. 

When  I  was  at  the  Villa  Celio,  about  a  year  and  a 
half  after  Italy  entered  the  war,  there  had  been  over 
thirty  thousand  sputum  examinations  made  and 
about  half  that  number  of  X-ray  studies.  And  this 
is  only  a  sample  of  the  thoroughness  and  efficiency 
of  the  work  done  by  the  Medical  Department  of  the 
Italian  Army.  At  the  great  General  Medical  Hos- 
pital (Ospedale  Contumaciale)  at  Udine,  only  thirty 
miles  behind  the  Front,  I  was  shown  records  of  some 
fifty  thousand  laboratory  tests  and  examinations 
made  within  the  year. 

Another  of  the  hospitals  in  Rome,  on  the  Lateran 
Hill,  close  to  the  famous  Sacred  Staircase  (Scala 
Santa),  which  the  faithful  ascend  upon  their  knees, 
had  two  large  wards  devoted  exclusively  to  the 
wounds  of  the  face  and  jaws.  Here  the  very  best  and 
most  modern  methods  of  both  dental  and  surgical 
repair,  described  in  an  earlier  chapter,  were  carried 
out  by  a  competent  staff,  and  it  was  a  matter  of  pa- 
triotic pride  to  find  that  two  of  the  most  enthusias- 
tic and  competent  dental  surgeons,  who  were  work- 


456  THE  DOCTOR  IN  WAR 

ing  these  miracles  of  repair  and  saving  the  poor 
wounded  from  a  lifelong  disfigurement  worse  than 
death,  were  graduates  of  American  schools. 

At  Udine  I  further  found  a  complete  hospital  of 
two  hundred  beds  situated  in  beautiful  grounds  and 
elaborately  equipped,  devoted  to  this  same  making 
of  new  faces  for  old. 

I  also  visited  two  admirable  hospital  schools  for 
the  double  purpose  of  making  and  fitting  the  best  and 
most  modern  type  of  artificial  limbs  for  soldiers  who 
had  lost  a  leg  or  an  arm,  and  at  the  same  time  teach- 
ing them,  during  the  period  that  they  were  being 
trained  to  wear  their  new  appliances,  how  to  adapt 
themselves  to  their  old  trades,  or  to  learn  new  ones 
better  suited  to  their  disabled  condition.  One  of 
these  was  most  beautifully  and  delightfully  housed 
in  a  wing  of  the  great  Royal  Palace  itself,  the 
Quirinal. 

The  very  throne-room  of  the  Palace,  which  had 
been  the  bed-chamber  of  a  mediaeval  Pope,  was 
turned  into  a  ward  and  the  Royal  Chapel  into  a 
store-room  for  bandages  and  linen. 

Another  beautiful  villa,  with  acres  of  superb  gar- 
dens and  grounds,  on  the  slope  of  the  great  Janiculan 
Hill,  had  been  turned  into  a  delightful  hospital  for 
cases  of  shell-shock  and  mental  strain.  If  the  view 
from  the  front  piazza,  including  in  its  sweep  almost 
the  whole  panorama  of  the  Eternal  City,  as  it  lay 


MOUNTAINS  AND  MEDICINE     457 

in  the  sunset  light  on  the  summer  evening  when  I 
visited  it,  would  not  start  a  shell-shock  in  the  direc- 
tion of  recovery,  I  don't  know  anything  in  the  world 
that  would. 

Most  of  the  Italian  hospitals  were  in  tall,  high- 
ceilinged  rooms,  with  abundance  of  great  windows, 
and  bare,  white  or  lightly  tinted  walls,  such  as  are 
customary  in  hot  climates  and  through  Latin  Europe 
generally.  This  was  true  both  in  the  buildings  which 
had  been  constructed  especially  for  hospitals  and 
those  which  had  been  simply  taken  over  and  adapted 
to  the  purpose  for  the  duration  of  the  war.  Every 
imaginable  tj^e  of  building  had  been  pressed  into 
the  service  of  healing  in  this  way,  convents,  colleges, 
palaces,  schools,  villas,  monasteries,  and  even,  in 
emergency,  churches  and  chapels,  which  were  gladly 
yielded  up  for  this  work  of  mercy  and  of  pity.  A 
greater  variety  of  architecture  and  of  forms  and  sizes 
of  wards  could  hardly  be  imagined,  but  they  all 
had  one  feature  in  common,  they  were  beautifully 
light  and  spotlessly  clean.  If  by  any  chcince  they 
were  n't  when  they  were  first  taken  over,  they  be- 
came so  before  the  Sanita,  or  Sanitary  Department 
of  the  Italian  Army,  got  through  with  them. 

If  the  walls  and  ceilings  were  not  absolutely  im- 
maculate, they  were  hosed  down  with  bichloride 
solution  and  then  given  a  coat  of  whitewash  or  kal- 
somine  in  some  delicate  tint.   In  many  of  them,  with 


458  THE  DOCTOR  IN  WAR 

that  natural  and  instinctive  taste  which  Italians  of 
all  grades  of  social  rank  possess,  a  light  band  of  sten- 
cil work  in  attractive  colors  was  run  round  the  walls 
or  over  each  of  the  great  windows,  and  the  effect 
was  extremely  pleasing.  Most  of  the  floors  were  of 
stone  or  concrete,  so  that  it  was  easy  to  keep  them 
clean,  and  if  in  poor  repair,  to  give  them  a  fresh  sur- 
face coat  of  cement.  There  were  no  rugs  or  carpets 
on  the  floor,  except  sometimes  a  single  strip  down  the 
aisle,  and  no  pictures  or  elaborate  hangings  about  the 
windows  to  catch  dust,  and  no  corners  in  which  dirt 
could  lurk  undetected,  and  the  net  result  was  that 
the  whole  group  of  them  impressed  one  as  among  the 
most  spotless  and  beautifully  clean  wards  and  build- 
ings which  it  would  be  possible  to  find  anywhere. 

The  kitchens  and  sculleries  and  outhouses  and  rear 
premises  were  kept  equally  immaculate,  every  scrap 
of  garbage,  every  dustpan  or  shovelful  of  dirt,  was 
sprinkled  with  kerosene,  placed  in  a  primitive  brick 
or  stone  furnace,  and  burned.  So  that  much  to  my 
surprise  and  delight,  in  the  very  worst  month  of  the 
year  in  that  scorching  hot  climate,  August,  I  found 
practically  no  flies  in  the  wards  or  kitchens  and  out- 
buildings, although  the  windows  were  for  the  most 
part  unscreened. 

What  was  more  unexpected  still,  this  miracle  of 
flylessness  was  achieved,  not  only  in  the  great  Base 
Hospitals  in  the  cities  and  towns,  but  even  in  most 


MOUNTAINS  AND  MEDICINE     459 

of  the  Ospedali  da  Campo  and  Ospedaletti  da  Campo 
in  the  little  villages  and  camps  just  behind  the  Front. 
The  transport  stables  and  artillery  and  cavalry  lines 
were  kept  well  off  by  themselves,  and  every  scrap  of 
manure  either  piled  up  and  sprinkled  with  kerosene 
and  burnt,  or  carted  away  by  the  thrifty  and  enter- 
prising peasantry  and  spread  at  once  on  the  land. 

But  the  vigilance  and  passion  for  cleanliness  of  the 
Sanita  did  not  end  even  here.  They  were  thoroughly 
awake  to  the  dangers  and  unhealthfulness  of  dust  as 
well  as  of  flies,  and  actually  had  the  superb  audacity 
to  attack  this  intolerable  nuisance  of  an  army  in  the 
field  and  endeavor,  as  nearly  as  possible,  to  wipe  it 
out,  and  that  in  a  climate  resembling  that  of  our  own 
Arizona  or  Southern  California. 

And  they  were  astonishingly  successful.  They  at 
first  tackled  the  chief  and  most  constant  source  of 
dust  in  any  climate,  the  roads.  The  world  is  ringing 
with  the  triumph  of  the  Italian  engineers  in  road- 
building,  mountain-piercing,  bridge-making,  etc.,  and 
the  superb  system  of  beautifully  built  and  kept 
roads,  which  covered  the  Venetian  and  Friulian  plains, 
to  serve  as  the  main  arteries  of  the  army  fighting  in 
the  mountains  that  bounded  them  on  the  north  and 
east,  was  not  the  least  of  their  achievements.  They 
were  superbly  laid  and  graded,  with  a  surface  as  hard 
a,nd  level  as  a  billiard  table ;  in  fact,  I  have  never  seen 
anywhere  in  the  finest  park  boulevards  or  famous 


460  THE  DOCTOR  IN  WAR 

city  driveways  anything  finer  in  the  form  of  road 
surfaces.  But  they  were  built  chiefly  of  limestone, 
and  with  the  incessant  stream  and  rumble  of  traffic 
that  poured  over  them,  to  say  nothing  of  the  tramp 
of  hundreds  of  thousands  of  marching  feet  backward 
and  forward  along  them  day  and  night,  would  mean 
dust  of  a  flour-like  fineness  and  penetration,  in  clouds 
and  clouds. 

But  the  ingenuity  of  the  Italians  was  not  baffled 
for  a  moment.  The  country  is  a  rich  alluvial  deposit, 
one  continuous  checker-board  of  vineyards  and 
orchards  and  cornfields,  but  thirsty  in  summer-time 
and  has  to  be  irrigated  through  ditches  with  water 
drawn  from  the  mountain  streams.  Nothing  was 
easier  than  to  have  a  couple  of  these  irrigating  ditches 
running  one  along  each  side  of  every  road ;  then  an 
army  of  old  men  and  boys  is  drawn  up  in  scattered 
ranks  on  either  side  of  the  highway  and  set  to  work, 
first  of  all,  sweeping  all  dust  and  dried  horse  manure 
and  other  dirt  which  is  deposited  upon  the  hard 
white  surface  of  the  road,  shoveling  it  into  wheel- 
barrows and  wheeling  it  out  on  to  the  soil  of  the 
vineyards  and  cornfields  on  either  side. 

As  fast  as  this  is  done  by  one  division,  another 
division  deploys  into  action  armed  with  curious 
long-handled  wooden  scoops  or  hollowed  shovels, 
with  which  they  dextrously  scoop  up  the  water  out 
of  the  irrigating  ditch  and  send  it  flying  across  the 


MOUNTAINS  AND  MEDICINE     461 

clean  white  surface  of  the  road.  The  bulk  of  the 
sweeping  is  done  at  night  when  the  traffic  is  lighter, 
but  this  primitive  scoop  sprinkling  is  kept  up  all  day 
long.  Everywhere  that  you  drive  you  can  see  the 
little  jets  of  spray  shooting  up  from  both  sides  of  the 
road.  The  system  works  like  a  charm,  how  perfectly 
may  be  gathered  from  the  fact  that  during  the  three 
August  weeks  which  I  spent  in  motoring  up  and  down 
the  Front  and  backward  and  forward  along  these 
roads  from  Headquarters  and  the  Bases,  I  never 
once  found  it  necessary  to  wear  a  dustcoat,  let  alone 
goggles  or  a  veil,  and  only  upon  one  or  two  occasions 
was  there  enough  dust  in  the  air  to  attract  attention. 
The  difference  which  this  triumph  over  road  dust 
made  to  both  the  comfort  and  the  health  of  the  march- 
ing columns,  to  say  nothing  of  the  poor  horses  and 
mules,  can  easily  be  imagined  but  hardly  overesti- 
mated. It  was  actually  found  to  diminish  markedly 
the  amount  of  catarrh  and  other  irritations  of  the 
nose,  throat,  and  eyes  of  the  soldiers,  and  to  keep 
their  feet  in  very  much  better  condition,  less  likely 
to  chafe  and  blister  on  the  march,  while  if  chafes  or 
blisters  did  form,  they  healed  more  rapidly  and 
kindly  than  when  exposed  to  the  often  infected  and 
poisonous  dust  of  the  ordinary  roads.  It  is  only  fair 
to  add  that  there  was  another  purpose  also  for  this 
painstaking  campaign  against  dust,  and  that  was 
that  the  majority  of  these  roads  were  not  only  in 


462  THE  DOCTOR  IN  WAR 

plain  view  of  the  Austrian  observation  posts  up  in 
the  mountains,  which  overlooked  them,  but  exposed 
to  shell-fire  from  the  Austrian  guns.  Hence  it  was  of 
the  greatest  importance  that  the  Austrian  observers 
should  not  be  able  to  detect  readily  extensive  troop 
movements  by  the  columns  of  dust  sent  up,  and  also 
that  the  roads  themselves  should  not  advertise  too 
constantly  and  obtrusively  their  own  position,  so  as 
to  give  their  range  to  enemy  gunners.  So  that  the 
Sanita  had  the  weighty  and  influential  backing  of 
the  General  Staff  and  of  the  line  in  their  brilliant 
attack  upon  che  dust  nuisance.  But  such  was  the 
addition  to  the  marching  power  and  comfort  of  the 
troops  and  the  cleanliness  and  freedom  from  dust  and 
grit  of  the  guns  and  other  elaborate  machinery  of 
war  transported  over  these  roads,  that  the  line  officers 
frankly  admitted  that  the  work  was  well  worth  all 
it  cost,  even  apart  from  its  value  in  concealing  the 
movements  of  troops  or  of  supply-trains  from  the 
enemy. 

Similar  precautions  of  constant  sprinkling,  com- 
bined with  the  burning  or  burying  of  all  sweepings 
and  camp  waste,  were  carried  out  in  most  of  the 
camps  in  the  plains,  to  the  great  advantage  and  com- 
fort both  of  the  troops  and  of  the  wounded  in  the 
hospitals  about. 

The  same  precautions  were  taken  with  the  batter- 
ies and  gun  emplacements,  and  I  was  considerably 


MOUNTAINS  AND  MEDICINE     463 

amused,  on  visiting  some  of  the  English  heavy 
artillery  posts  on  the  edges  of  the  Corso,  to  hear  the 
men  grumbling  about  the  fag  and  nuisance  of  per- 
petually hauling  water  in  carts  and  casks  from  a 
river  or  pool  a  couple  of  miles  away,  in  order  to  keep 
the  ground  around  the  belching  monsters  well  wet 
down,  so  that  the  tremendous  shock  of  their  recoil 
would  not  send  the  telltale  cloud  up  intp  the  air  to 
furnish  a  clue  to  the  Austrian  batteries  above  them. 
One  somehow  had  never  thought  of  a  water  cart  as 
part  of  the  necessary  equipment  of  a  nine-inch  gun. 

A  more  ideally  beautiful  theater  of  war  could 
hardly  be  imagined  than  the  broad  green  Venetian 
plain,  bounded  on  the  left  by  the  crescentic  rampart 
of  the  Julian  Alps  sweeping  down  to  Trieste  and  the 
Gulf  in  front,  and  by  the  violet  blue  waters  of  the 
Adriatic  on  the  right.  The  plain  was  intersected 
every  three  or  four  miles  by  the  shallow  valleys  of 
swift,  sparkling,  mountain  streams,  which  in  the 
summer-time  sank  into  the  earth  before  they  reached 
the  sea,  like  the  rivers  of  Southern  California,  and 
dotted  all  over  with  scores  of  little  gray-walled  vil- 
lages and  venerable  towns,  each  with  its  tall  white 
church- tower,  half  spire,  half  watch-tower  against 
Moorish  and  Turkish  pirates.  Every  one  of  these 
little  villages  was  swarming  with  troops  and  ringed 
about  with  camps.  And  every  one  had  furnished 
from  two  to  five  or  six  high- vaulted,  white- walled 


464  THE  DOCTOR  IN  WAR 

rooms  for  use  as  hospitals.  The  result  was  some  most 
picturesque  and  striking  contrasts.  In  one  village  I 
saw  wounded  Arditi  and  bandaged  Bersaglieri  lying 
in  cots  with  their  heads  just  under  the  gilded  frame 
of  a  magnificent  painting  valued  at  twenty  thousand 
dollars,  with  the  rest  of  the  equipment  on  the  walls 
to  match.  This  was  in  the  villa  of  one  of  the  Italian 
nobility,  and  it  had  other  advantages  as  a  hospital 
besides  its  beautiful  pictures  and  magnificent  furni- 
ture. The  wife  of  the  nobleman  happened  to  be  an 
Austrian  princess  and  as  a  consequence,  although  all 
the  villages  and  camps  round  about  were  scourged 
time  and  again  by  the  Austrian  fire,  not  a  single  shell 
ever  fell  upon  this  villa  or  in  the  little  village  clus- 
tered round  the  foot  of  the  hill  on  which  it  stood. 
German  and  Austrian  gunners  may  not  intentionally 
shell  hospitals,  but  they  certainly  can  intentionally 
miss  them  when  they  want  to. 

Another  romantic  illustration  of  their  powers  of 
sparing  certain  buildings  and  regions  was  furnished 
on  this  same  Italian  Front,  not  twenty  miles  away 
from  this  hospital  villa.  Right  on  the  crest  of  one 
of  the  highest  ridges,  which  the  Italian  troops  had 
wrested  from  the  Austrians  after  furious  fighting,  and 
looking  directly  down  upon  the  valley  of  the  Isonzo 
where  the  armies  were  locked  in  mortal  combat  all 
summer  long,  was  a  little  memorial  chapel  known  as 
Santa  Maria  Zan.   Every  village  and  every  church. 


MOUNTAINS  AND  MEDICINE  ~  465 

within  five  miles  of  it  on  either  side  and  behind,  had 
been  battered  into  a  mass  of  ruins;  but  its  slender 
tower  still  rose  toward  the  sky  untouched,  with  not 
even  a  slate  missing  from  its  roof.  The  reason  given 
for  its  singular  immunity  was  that  one  of  the  favor- 
ite mistresses  of  the  earlier  and  happier  days  of  the 
Emperor  Franz  Josef  was  buried  there.  And  as  her 
tomb  was  plain  to  be  seen  just  to  the  side  of  the 
altar  and  no  other  conceivable  reason  could  be  im- 
agined for  its  escape,  the  explanation  was  at  least 
highly  probable. 

I  found  another  group  of  wounded  soldiers  lying 
in  comfortable  white  cots  in  the  dim  religious  light 
of  stained-glass  windows  in  a  beautiful  old  church, 
or  rather  chapel  of  a  monastery.  At  the  other  end  of 
the  scale,  one  of  the  busiest  war  hospitals  which  I 
visited  was  in  an  abandoned  railway  tunnel,  drilled 
through  the  wall  of  the  cliff-sided  gorge  of  the  Isonzo, 
another  was  in  the  entrance  to  an  abandoned  mine 
in  the  side  of  Monte  Vodice,  but  in  all  of  them  alike, 
the  wounded  had  had  the  best  of  attention  and  were 
resting  as  comfortably  as  their  wounds  would  permit. 

Two  of  the  most  picturesque  hospitals  that  I 
saw  on  the  Isonzo  Front  were  in  great,  roomy,  old- 
fashioned  bams  and  granaries,  with  the  huge  roof 
beams  and  the  under  side  of  the  tiles  for  their  only 
ceiling.  But  these  again  had  been  thoroughly  house- 
cleaned  and  whitewashed  from  floor  to  roof -peak  by 


466  THE  DOCTOR  IN  WAR 

the  Sanita,  and  in  one  of  them  the  wounded  thought 
they  were  in  clover  and  gave  themselves  great  airs 
of  superiority,  because  they  were  in  the  hands  of 
the  EngHsh  Red  Cross  and  waited  upon  by  trained 
women  nurses. 

The  most  striking  one  of  the  whole  series  was  the 
great  riding-school  of  a  big  cavalry  barracks,  which 
had  been  converted  into  a  single  oval  ward  over  six 
hundred  feet  long  and  with  eleven  hundred  cots  ar- 
ranged in  orderly  rows  upon  its  floor.  As  it  was  over 
sixty  feet  high  in  the  center,  its  spotless  white  arching 
roof  and  delicately  tinted  walls,  with  its  brilliant 
light,  made  it  look  like  a  literal  temple  of  light  and 
healing,  though  it  must  have  been  a  fearful  business 
to  try  and  keep  it  warm  in  winter-time. 

One  new  and  interesting  feature  which  the  charac- 
ter of  the  country  fought  over  has  brought  about  is 
the  great  variety  of  means  for  the  transportation  of 
the  wounded.  First  and  far  most  frequent  of  all  come 
the  great  motor  ambulances,  many  of  them  of  their 
own  splendid  Italian  makes  —  Fiats,  Lancias,  and 
the  like.  Everjrwhere  that  the  superb,  boulevard- 
wide,  billiard-table-level,  military  roads  of  the  Ital- 
ian engineers  go  —  and  they  go  pretty  nearly  every- 
where—  these  rubber-tired,  one-car  hospital  trains 
de  luxe  roll  up  to  the  Dressing-Stations  and  roll  down 
again  with  the  wounded  in  comfort  and  safety  and 
speed.  Just  as  an  illustration  of  what  their  engineers 


MOUNTAINS  AND  MEDICINE  '467 

can  do,  I  rode  in  a  big  Army  limousine  over  a  splen- 
did road,  with  a  surface  like  a  floor,  climbing  in  great 
sweeps  and  spirals  right  up  to  within  a  few  hundred 
yards  of  the  front-line  trenches  along  the  crest  of 
Monte  Vodice,  over  three  thousand  feet  above  the 
waters  of  the  Isonzo,  within  three  weeks  of  the  day 
that  it  had  been  captured  from  the  Austrians! 

The  only  drawback  to  travel  on  these  magnificent 
roads  is  that  their  inner  side  is  a  perpendicular  wall 
of  rock,  their  outer  a  sheer  drop  of  hundreds  of  feet 
into  the  valley  below,  and  your  motor,  being  the 
lighter  and  more  mobile  vehicle,  has  to  take  the 
outer  edge  and  give  the  wall  to  the  ammunition 
wagons  and  motor  "camions."  And  there  is  no 
parapet,  not  even  a  hand-rail,  if — ! 

But  then,  as  one  of  Mr.  Shaw's  topsy-turvy  Cock- 
ney heroes  remarks:  ''Hif  you  wunst  begins  to  think 
—  then  good-bye  'appiness!"  So  you  don't,  but  just 
sweep  blissfully  onward  through  the  gap  between  the 
drop  and  the  dynamite. 

Next  after  the  lordly  Fiats  come  the  old-fashioned 
wooden- wheeled,  horse-  or  mule-drawn  ambulances 
which,  though  with  jolts  and  joggles  incarnate,  can 
scramble  up  steep-sided  gullies  or  over  rocky  ledges 
and  boulder-strewn  mountain  fords,  where  the  rubber 
shoe  of  the  motor  could  scarce  dare  a  foothold.  Ex- 
cept for  short  distances  in  rough  and  difficult  country 
they  are  now  chiefly  used  for  the  transportation  of 


468  THE  DOCTOR  IN  WAR 

the  walking  wounded,  carry-all  fashion,  or  for  dis- 
tributing the  less  seriously  injured  from  the  great 
Collecting-Stations  a  mile  or  so  behind  the  Front  to 
the  near-by  field  and  village  hospitals,  where  the 
roads  are  comparatively  level.  I  visited  one  of  these 
Collecting-Stations  about  five  o'clock  in  the  after- 
noon, which  had  handled  fourteen  hundred  wounded 
since  daybreak  that  morning,  and  they  were  still 
pouring  in.  i 

Then  come  curious  country  carts  drawn  by  sure- 
footed little  mountain  ponies  or  donkeys,  curious  to 
look  upon  and  jolty  to  ride  in,  but  capable  of  twist- 
ing their  devious  way  up  or  down  almost  any  moun- 
tain-side. And  for  the  still  more  difficult  places  were 
litters,  or  long-shafted  stretchers  slung  between  two 
furry-eared  donkeys  or  a  couple  of  shaggy  ponies; 
and  last  of  all,  of  course,  the  old  reliable  and  abso- 
lutely indispensable  hand-stretcher,  carried  between 
two  bearers,  or  in  difficult  places  lifted  high  on  the 
shoulders  of  four. 

But  the  most  unique  and  effective  means  of  bring- 
ing down  the  wounded  in  high  mountain  fighting  was 
the  miniature  cable-railway,  or  "telef erica,"  one  of 
which  was  in  full  swing  just  behind  the  busy  Collect- 
ing-Station bringing  down  the  wounded  from  the 
tops  of  Monte  Kuk^a  mile  and  a  half  away  across 
the  valley. 

These  wonderful  little  air-line  trolleys,  whose  glit- 


TRANSPORTATION  OF   WOUNDED   BY   TROLLEY  IN   THE 
ITALIAN   MOUNTAINS 


MOUNTAINS  AND  MEDICINE     469 

tering  cables  of  woven  and  twisted  steel  festoon  all 
the  mountain  chains  of  the  Italian  Front,  like  a  giant 
spider's  web,  loop  peak  to  peak,  and  mountain-side  to 
mountain-side  across  the  gulf  between,  like  the  flight 
of  a  bird,  or  leap  from  the  bare  brink  of  the  precipice 
down  to  the  green  valley  below  in  one  swoop  and  up 
to  the  glaciers  above  in  another. 

They  did  not  originate  in  this  war,  any  more  than 
most  of  the  other  agencies  which  it  employs,  but  have 
been  in  use  for  years  in  mining  operations  in  moun- 
tainous regions,  particularly  in  the  South  American 
Andes.  And  as  the  Italians  are  extensively  interested 
in  many  enterprises  in  South  America,  particularly 
in  the  Argentine,  their  engineers  brought  back  with 
them  the  idea  of  the  overhead  cable  trolley  and  pro- 
ceeded to  adapt  it  for  military  purposes.  It  has 
proved  so  extraordinarily  useful,  in  such  an  infinite 
variety  of  ways,  that  it  would  be  really  difficult  to 
conceive  what  this  war  would  be  like  in  the  high 
mountains  without  it.  It  plays  as  important  a  part 
among  the  peaks  and  mountain  valleys  as  the  motor 
does  in  the  plains  below. 

In  principle  and  construction  it  is  simplicity  itself, 
just  a  double  line  of  swaying  steel  cable  from  half  a 
mile  to  a  mile  and  a  half  long  stretched  up  the  side 
of  a  mountain,  across  a  valley,  or  in  relays  down 
the  whole  length  of  it,  with  little  basket-cars  slung 
on  it  on  a  deep-grooved  trolley  wheel  and  drawn 


470  THE  DOCTOR  IN  WAR 

by  a  smaller  and  lighter  cable  wound  over  a  rolling 
drum. 

The  passengers,  food,  ammunition,  or  supplies  are 
placed  in  the  little  basket-car  of  perforated  sheet  steel 
and  sent  sailing  and  swaying  swiftly  and  merrily  up 
or  down  the  face  of  a  precipice,  or  across  a  mountain 
gorge  with  the  roaring  torrent  brawling  Heaven 
knows  how  many  hair-raising  thousands  of  feet  be- 
low, until  with  a  jerk  and  a  click  you  arrive  along- 
side of  a  narrow  platform  like  the  one  you  started 
from,  climb  out  of  your  basket,  walk  across  the  plat- 
form, scramble  into  another  basket,  and  off  you  go 
with  a  heave  and  a  swoop  on  the  next  stage  of  your 
journey. 

Where  the  cables  can  be  securely  braced,  or  sup- 
ports can  be  slipped  in  at  intervals,  these  flying  bird- 
cages, these  spider-trolleys  can  sail  a  mile  or  even  a 
mile  and  a  half  at  a  stretch,  but  ordinarily  they  are 
laid  out  in  flights  of  about  half  to  three  quarters  of 
a  mile,  with  a  platform  and  station-house  sheltering 
the  gasoline  engine,  which  drives  the  drum  and  sup- 
plies the  motor  power,  at  the  end  of  each  section. 

As  each  section  or  unit  of  the  line  costs  roughly 
about  ten  thousand  dollars  including  price  of  gaso- 
line-engine, cables,  cars,  and  installation,  though 
this  last,  of  course,  varies  considerably  with  the  lo- 
cation, and  as  each  car  will  carry  six  hundred  pounds 
and  can   be  run  at  about  two  minutes'  intervals 


MOUNTAINS  AND  MEDICINE     471 

(headway),  they  are  not  an  expensive  form  of  trans- 
portation. Indeed,  in  that  sort  of  country  and  by 
comparison  with  the  cost  of  carrying  by  pack-mules 
and  trails,  they  are  remarkably  cheap.  And  where 
time  is  a  consideration  they  are  literally  **out  of 
sight"  of  the  pack-trains.  For  instance,  the  series 
of  five  mortal  risks  by  which  I  sailed  from  the  valley 
up  to  the  glacier,  eleven  thousand  feet,  on  Monte 
Adamello,  in  the  Trentino,  landed  me  gasping  on  the 
eternal  snow  in  a  little  less  than  an  hour  and  a  quar- 
ter, while  the  same  climb  on  mule-back  would  have 
taken  eight  and  a  half,  and  with  pack-mules  four- 
teen hours. 

The  flying  tea-tray  could  make  almost  twelve  trips 
while  the  pack-mules  were  making  one.  But  it's  a 
gulpy  and  giddy  sort  of  "proposition"  at  first.  You 
walk  into  the  little  shed  station,  where  your  big  mili- 
tary motor  has  dropped  you  after  a  nerve-testing 
climb  up  extraordinary  zigzags  and  around  extremely 
unprotected  corners,  with  as  brave  and  nonchalant 
an  air  as  possible,  and  cast  a  glance  at  the  shiny 
twin  cables  that  go  sweeping  up  to  your  first  landing- 
perch  on  a  shelf  twelve  hundred  feet  above  you. 

So  far,  so  good.  They  look  as  if  they  might  hold 
you  up  —  if  nothing  went  wrong.  Then  you  turn 
around  and  look  for  your  car,  expecting  to  see  some- 
thing resembling  a  small  elevator-cage,  or  at  least  a 
deep-seated  basket  intowhich  you  could  snuggle 


472  THE  DOCTOR  IN  WAR^ 

down  and  fasten  the  cover  over  the  top  of  you.  But 
you  see  nothing  of  the  sort,  and  finally  you  ask  where 
it  is  and  your  officer-guide,  politely  struggling  to  hide 
a  smile,  points  it  out  to  you  right  under  your  very 
feet.  And  there,  lying  close  alongside  of  the  little 
twelve  by  six  platform,  is  a  ghastly  little  tea-tray  of  a 
thing  about  the  shape  and  solidity  of  one  of  these 
little  wire-mesh  baskets  that  run  along  the  ceiling 
and  bring  you  back  your  parcels  and  change  in  a  de- 
partment store  —  only  smaller! 

As  a  matter  of  fact,  it  is  about  six  feet  long,  three 
feet  wide,  by  six  inches  deep,  though  it  looks  to  your 
horror-stricken  eyes  of  about  the  dimensions  of  a  pen- 
tray,  or  one  of  these  baskets  on  a  desk  in  which  **  in- 
coming" or  "answered"  letters  are  kept. 

The  bottom  is  solid,  thank  God,  but  the  blither- 
ing six-inch  sides  are  all  perforated  open-work,  which 
makes  them  look  about  as  solid  and  protective  as  a 
strip  of  mosquito-netting.  But  it  was  the  ends  that 
gave  you  palpitation  of  the  heart.  They  were  ori 
hinges  and  were  laid  back  wide  open,  as  the  car 
had  just  been  carrying  lumber. 

When  I  could  get  my  breath,  I  jerked  out:  **For 
Heaven's  sake,  shut  those  end-gates!"  And  we  were 
to  swoop  up  the  mountain-side  in  that  magnified 
pie-pan,  without  even  a  crust  over  us,  and  nothing 
whatever  above  us  or  on  either  side  in  the  way  of  sup- 
port  or  protection  but  that  single  spider-web  cable 


MOUNTAINS  AND  MEDICINE     473 

against  the  blue,  blue  sky  and  the  iron  fork  which 
hung  us  from  our  trolley-wheel  above. 

I  don't  mind  confessing  that  I  played  "Safety 
First "  and  lay  flat  on  my  back  on  that  flying  cot  try- 
ing to  dig  my  shoulder  blades  into  the  floor  under- 
neath, and  gazing  hopefully  up  into  the  blue  sky  to 
try  and  forget  the  six  hundred  feet  of  empty  space 
which  came  between  me  and  the  rocks  and  trees 
below. 

But  on  the  second  stage  I  ventured  to  lift  my  head 
and  cautiously  peek  over  the  six-inch  rail  into  the 
depths  beneath.  On  the  third  I  sat  up  and  began  to 
admire  the  scenery,  and  by  the  fourth  I  had  to  be 
cautioned  not  to  hold  my  head  so  high  when  I  was 
going  under  the  "low  bridge"  arch  of  an  extra  sup- 
port. After  that  I  was  ready  to  skate  off  anywhere 
on  a  "telef erica,"  and  was  only  inclined  to  regret 
that  they  could  n't  be  used  on  the  level  in  the  dull 
world  below. 

Really  the  motion  is  distinctly  pleasant,  and  the 
sensation  of  sweeping  free  through  the  air  quite  ex- 
hilarating, after  you  once  get  over  the  first  feeling  of 
awkwardness  and  can  forget  to  think  about  what 
might  happen  if  the  cable  broke  or  an  enemy  shell  hit 
it  or  your  trolley  ran  off  or  the  hauling  line  snapped. 
Also  my  guide  informed  me  that  in  the  event  of  a 
sudden  squall  of  wind,  quite  common  among  those 
mountains,  the  cable  would  get  to  swaying  so  vio- 


474  THE  DOCTOR  IN  WAR 

lently  that  it  was  n't  safe  for  the  engine  to  wind  up  any 
further  on  the  Hne  for  fear  of  breakages,  and  you  just 
had  to  stay  out  there  and  swing  back  and  forth,  pen- 
dulum fashion,  until  you  gradually  ** cat-died"  to  rest 
again  and  could  be  hauled  on  up  to  the  top.  The  sec- 
ond party  before  us  had  been  caught  in  just  such  a 
squall  and  had  done  the  ''Rock-a-bye-baby"  act  for 
nearly  an  hour  and  a  half  before  it  was  safe  to  haul 
them  on  again. 

Another  thing  which  caught  my  anxious  and  in- 
quiring eye  was  the  utter  absence  of  anything  in  the 
slightest  degree  resembling  a  brake  on  the  machine. 
I  asked  my  officer-guide  and  he  replied,  with  a  reas- 
suring smile,  ''Oh,  it  is  unnecessary,  quite  unneces- 
sary, Signore.'*  "Oh,  I  see,  we  could  grab  the  cable 
with  our  hands  and  hold  ourselves,  couldn't  we?'* 
''Have  no  fear,  Signore,  have  no  fear,"  he  smiled 
again,  ''if  the  drum  line  should  ever  break,  nothing 
under  the  blue  heaven  could  stop  us  until  we  arrived 
at  the  platform  below,  and  of  that,  of  course,  we 
should  know  nothing.  So  why  worry  about  such  a 
trifle  as  the  absence  of  a  brake  ?  " 

But  one  soon  learns  to  forget  such  considerations 
as  these  and  to  console  one's  self  with  the  comfort- 
ing practical  thought  that  as  a  matter  of  fact  the 
lines  are  so  well  built  and  the  cables  so  carefully 
woven  and  tested  that  there  have  been  surprisingly 
few  fatal  or  serious  accidents  on  these  "telef erica" 


MOUNTAINS  AND  MEDICINE     475 

lines.  Though  I  never  got  to  feel  quite  comfortable 
coasting  with  both  end-gates  down,  especially  the 
lower  one,  which  I  once  discovered  just  as  we  had 
swooped  about  a  hundred  feet  below  the  perch. 

But  they  are  God's  mercy  to  the  poor  wounded, 
who  fall  on  the  glaciers  or  on  the  high  mountain- 
slopes.  In  fact  no  other  method  of  transportation 
whatever  can  compare  with  these  flying  cots  in 
smoothness,  swiftness,  and  utter  absence  of  jolt  or 
jar  or  unpleasant  movement  of  any  description. 

They  had  done  yeoman  service  only  about  six 
weeks  before  my  visit,  bringing  down  over  six  hun- 
dred from  the  battle  of  Corne  Caventi,  fought  in 
trenches  cut  in  the  solid  glacier  ice,  nearly  thirteen 
thousand  feet  above  the  sea. 

But  this  battle  above  the  clouds  was  fought  some 
three  miles  beyond  the  highest  Alpine  garrison  post 
and  seven  miles  of  crevasse-seamed  glacier  surface 
lay  between  its  trenches  and  the  topmost  platform  of 
the  last  "telef erica."  How  were  the  wounded  to  be 
transported  across  this  gap?  By  the  last  and  most 
picturesque  of  ambulances  on  this  romantic  front, 
Eskimo-dog  sledges,  each  drawn  by  two  big  woolly 
''huskies,"  or,  as  the  Alaskans  say,  "malamoots." 

A  rough  sledge-track  was  broken  out  and  trampled 
down  across  the  humpy  and  rolling  surface  of  the 
glacier,  which  looked  much  as  if  a  rather  dirty  ocean, 
with  a  choppy  sea  on,  had  suddenly  been  frozen 


476  THE  DOCTOR  IN  WAR 

stiff.  Though  it  wound  in  and  out  to  avoid  the 
worst  of  the  bottomless  cracks,  which  criss-crossed 
the  glacier  in  every  direction  and  surged  up  and 
down  over  the  long  swells  of  the  frozen  sea,  the 
sledges  would  ride  over  it  without  many  serious  or 
troublesome  jolts  or  jerks,  so  that  the  wounded, 
well  bandaged  and  wrapped  up,  made  the  crossing 
in  comparative  comfort  and  were  safely  delivered  at 
the  topmost  platform  of  the  ''telef erica." 

From  this  they  were  lifted  without  change  or  dis- 
turbance, still  in  their  stretchers,  right  into  the  steel 
basket,  and  were  shot  gently  and  swiftly  downward 
with  only  one  "change  of  cars,"  and  even  then  the 
Pullman  berths  went  right  through,  to  the  Refugio 
Garibaldi,  the  highest,  if  not  the  greatest,  hospital  in 
the  world,  perched  on  a  little  valley  shelf  among  the 
peaks  and  above  a  precipice  nine  thousand  feet  in 
air.  Here  they  were  carefully  looked  over  by  the 
surgeons  to  see  that  everything  was  all  right  and 
ship-shape  about  the  dressings,  and  those  who  were 
in  serious  or  critical  condition  from  wounds  in  the 
head,  abdomen,  etc.,  were  taken  directly  to  the  Hos- 
pital, operated  upon,  and  kept  in  comfortable  wards 
until  they  were  able  to  travel  on  down  to  the  valley. 

There  were  only  about  twenty  of  these  bandaged 
heroes  left  in  the  Hospital  at  the  time  of  my  visit,  and 
they  were  all  convalescent,  the  others  having  recov- 
ered and  been  sent  on  down  the  mountain.    They 


MOUNTAINS  AND  MEDICINE  '  477 

looked  very  comfortable  and  happy  sitting  and  loung- 
ing on  the  green  slope  between  the  Hospital  and  a 
tiny  lake  in  the  saucer  of  the  wee  valley,  and  were 
formally  presented  to  me  by  the  young  surgeon  in 
charge  as  "the  blesseds  of  the  Adamello,"  which 
they  certainly  were  and  looked. 

For  the  more  lightly  wounded  it  is  only  three  more 
swoops  and  a  four-mile  roll  in  a  big  motor  ambulance 
over  perfect  roads  down  to  the  Field  Hospitals  in  the 
villages  of  the  upper  valley  or  a  ten-mile  one  to  the 
big  Base  Hospitals  in  the  bustling  town  among  the 
meadows  in  the  main  valley  below. 

These  dog-teams  and  sledges  were  in  constant  use 
up  on  the  glacier  as  the  chief  means  of  transportation 
for  all  sorts  of  supplies  from  the  main  post  at  the  top 
of  the  "telef erica"  to  the  advanced  garrison  outpost 
three  miles  away  across  the  glacier:  partly  on  account 
of  the  difficulty  and  expense  of  hauling  up  the  bulky 
fodder  and  grain,  which  would  have  been  needed  for 
mules  or  ponies,  but  more  on  account  of  the  narrow 
and  constantly  shifting  trails  across  the  dangerous 
crevasses  of  the  glacier.  The  whole  surface  of  the 
glacier  was  seamed  on  an  average  about  every  hun- 
dred yards  with  these  perilous  fissures,  most  of  them 
fortunately  only  six  inches  to  a  couple  of  feet  in 
width,  but  if  you  looked  down  into  them  as  your 
sledge  was  being  dragged  across  them,  you  gazed 
into  steely  blue  depths  that  made  you  shiver. 


478  THE  DOCTOR  IN  WAR 

As  my  officer-guide  facetiously  remarked,  just 
after  crossing  one  of  them,  which  was  fully  half  as 
wide  as  my  sled-runners  were  long:  *'If  you  wish  to 
become  immortal,  Signor  Dottore,  all  you  have  to 
do  is  to  plunge  in  there.  You  will  be  beautifully  pre- 
served in  cold  storage  for  perhaps  two  hundred  years 
and  then  reappear  to  the  admiring  public  eye,  as  nat- 
ural as  life,  at  the  foot  of  the  glacier  below."  I  said 
I  would  think  about  it  later  when  all  other  hopes 
of  leaving  anything  to  be  remembered  by  had  failed. 

But  these  children  of  the  high  Alps  don't  let  little 
things  like  that  worry  them  in  the  least;  as  long  as 
the  crevasses  across  the  trail  are  not  more  than  eight- 
een inches  wide,  so  as  to  be  bridged  by  the  runners  of 
the  dog-sledges  with  a  foot  to  spare  at  each  end,  they 
pay  no  attention  to  them,  but  just  ride  straight 
across. 

When  they  open  to  a  width  of  two  feet  or  more, 
they  take  two  or  three  planks  or  the  top  of  a  packing- 
case,  lay  it  across  the  crevasse,  shovel  a  little  snow  on 
it  to  make  it  good  sledding,  and  then  the  traffic  goes 
merrily  on  over.  If  the  crack  gets  to  be  two  yards 
or  more  wide,  then  they  will  go  the  length  of  a  little 
wooden  bridge  of  inch  boards  with  a  hand-rail  on  one 
side.  Over  the  rail  of  one  such  massive  structure  we 
could  actually  look  down  into  a  huge,  violet,  cathe- 
dral-shaped ice  cavern,  as  big  as  the  Grand  Central 
Station,  along  the  peak  of  whose  roof  ran  our  ere- 


MOUNTAINS  AND  MEDICINE     479 

vasse  and  hear  the  brawling  of  the  glacier  stream 
eight  hundred  feet  below. 

The  only  animals  that  can  be  got  to  walk  across 
structures  like  that  are  dogs  and  men  —  mules  have 
too  much  sense.  Nor  was  the  danger  of  the  roof  of 
the  Grand  Central  Station  yawning  and  swallowing 
you  up  purely  imaginary.  At  the  main  garrison-post 
they  showed  us  great  caverns  which  had  opened  in 
the  ice,  beginning  as  mere  two-inch  cracks,  right  in 
under  the  side  of  one  of  the  barracks  and  the  end  of 
another,  so  that  they  had  to  be  perpetually  on  the 
lookout  and  ready  to  move  to  another  and  as  yet 
safer  site.  The  gulf  that  had  opened  under  the  end 
of  an  abandoned  cook-house  was  already  thirty  feet 
across  and  of  a  depth  that  ended  in  a  floor  of  blue 
haze. 

This  was  the  reason  why  they  used  those  curious 
shack-like  hut  shelters  up  in  that  region  of  intense 
cold,  because  they  would  straddle  lightly  over  the 
surface  and  were  too  long  to  fall  into  any  crevasse 
which  was  likely  to  open  suddenly,  and  also  could 
be  quickly  pulled  down  and  moved  to  safer  ground, 
or  even  snaked  along  the  surface  of  the  ice. 

The  dogs  had  a  special  big  barrack  of  their  own, 
just  as  tight  and  comfortable  as  those  of  the  soldiers. 
There  were  between  fifty  and  sixty  of  them  —  great, 
big,  handsome  fellows  —  with  thick,  wavy  or  shaggy 
coats  and  long,  wolf-like  tails,  looking  like  a  cross 


48o  THE  DOCTOR  IN  WAR 

between  a  rough-coated  St.  Bernard  and  a  big  hairy 
collie.  As  a  lifelong  dog-lover  and  breeder,  I  in- 
quired at  once  as  to  their  blood,  but  was  told 
that  they  were  of  no  particular  breed,  just  the  dogs 
used  by  the  shepherds  and  herdsmen  in  the  High 
Tyrol. 

Possibly  they  were  also  related  to  the  famous  dogs 
of  the  St.  Bernard  Pass,  who,  however,  were  probably 
developed  from  a  similar  if  not  a  common  stock.  In 
fact  the  head-keeper,  when  asked  if  they  weren't 
part  St.  Bernard,  replied  with  a  shrug  of  the  shoul- 
ders, "Ah,  yes,  perhaps;  but  perhaps  the  St.  Ber- 
nards are  half  them!  "  —  clearly  of  the  opinion  that 
there  were  other  famous  dogs  in  the  world  besides 
those  of  the  great  monastery. 

I  was  greatly  amused  to  find  that  these  devoted 
and  much-petted  dogs  were  not  only  treated,  but  also 
fed,  like  human  beings.  They  were  given  macaroni 
and  soup  and  rice,  with  great  ladlefuls  of  beans,  fla- 
vored with  cheese  or  dried  fish.  All  these  were  dished 
out  hot  and  smoking,  one  after  another,  into  great 
soup  platters,  such  as  the  soldiers  use,  laid  the  whole 
length  of  their  comfortable  kennel  hut,  between  two 
eagerly  waiting  lines  of  hungry  dogs.  They  sat  up  at 
strict  attention,  without  a  sound,  though  with  slob- 
bering lips,  until  the  last  ladleful  had  been  dished  out. 
Then  at  a  sharp  word  of  command  from  the  chief 
driver  they  sprang  forward,  like  a  shot,  and  cleaned 


MOUNTAINS  AND  MEDICINE     481 

up  every  platterf ul  to  the  last  drop  with  gleeful  gob- 
blings. 

The  Alpini  Commandant  assured  me  that  they 
could  not  keep  their  strength  and  endurance  on  any 
less  choice  and  nourishing  food;  indeed,  the  expense 
of  transportation  up  to  that  high  altitude,  twelve 
thousand  feet  above  sea  level,  was  so  great  that  it  was 
not  worth  while  bringing  up  any  except  the  best  and 
most  concentrated  foods.  To  crown  all,  he  informed 
me  that  the  head  driver,  who  loved  them  like  children, 
insisted  that  the  dogs  actually  needed  a  small  "shot" 
of  hot  coffee,  with  condensed  milk  and  sugar  in  it, 
every  morning  just  to  warm  up  their  stomachs  against 
the  bitter  mountain  cold,  for  the  day's  work;  just  as 
the  soldier  thinks  the  world  of  his  thimbleful  of  hot 
rum  in  the  early  dawn  in  the  trenches,  especially 
before  he  goes  over  the  top.  Dogs  are  very  much  like 
men  and  both  extremely  human,  after  all. 


THE  END 


CAMBRIDGE  .  MASSACHUSETTS 
U    .    S    .    A 


MAY  22 1  MAY  2  ^ 
A)AY:?4iMAY  24 


K0'J2V3T 


DEC 


J923 


BOSTON  COLLEGE 


3  9031   01511606  4 


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